title: A stiff bristled, spiral-shaped ectocervical brush: a device for transepithelial tissue biopsy.
abstract: OBJECTIVE
  To compare a new spiral-shaped tissue-sampling brush with a standard cervical punch biopsy.
  
  
  METHODS
  Before large loop excision of the transformation zone, women with cervical intraepithelial neoplasia underwent a transepithelial brush biopsy of a portion of a colposcopically identified lesion, followed by a punch biopsy of the remaining portion. Brush biopsy samples were processed using liquid-based cytology and cell block techniques. Diagnoses were made using a consensus of three pathologists. Brush biopsy samples without basal cells were considered inadequate. The histological diagnosis was compared with the brush biopsy and punch biopsy samples. Patient-reported pain and physician-reported bleeding for punch and brush biopsies were compared.
  
  
  RESULTS
  Fifty-two women were enrolled in the study; 47 successfully completed the study protocol. Eight brush biopsy specimens were inadequate. Thirty-nine women showed abnormal pathology (human papillomavirus/cervical intraepithelial neoplasia I or worse) on large loop excision of the transformation zone, and 32 women had high-grade (or worse) lesions. The punch biopsy correlated with high-grade disease in 53.1% of these women. The brush biopsy result correlated with high-grade disease in 79.3% of these women using a cell block technique and 76.7% using liquid cytology. There was significantly less pain (P <.001) and significantly less bleeding (P <.001) with the brush biopsy.
  
  
  CONCLUSIONS
  When an adequate sample is collected, spiral brush biopsy is as good as a standard punch biopsy for detecting cervical pathology, with substantially less pain and bleeding. User training and guidelines for sampling are needed to assure that an adequate sample is collected.
authors.affiliation: Department of Gynecologic Oncology, University of California at Irvine, Irvine, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Monk
authors.forename: Michael
authors.initials: M
authors.lastname: Cogan
authors.forename: Juan C
authors.initials: JC
authors.lastname: Felix
authors.forename: Neal M
authors.initials: NM
authors.lastname: Lonky
authors.forename: Joel S
authors.initials: JS
authors.lastname: Bentz
authors.forename: C Jay
authors.initials: CJ
authors.lastname: Marshall
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Cestero
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Rowe
authors.forename: Stewart A
authors.initials: SA
authors.lastname: Lonky
mesh_terms: D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation*; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D019092:Conization / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000295:instrumentation*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*