A stiff bristled, spiral-shaped ectocervical brush: a device for transepithelial tissue biopsy.
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.
Monk
Bradley J
BJ
Department of Gynecologic Oncology, University of California at Irvine, Irvine, USA.
Cogan
Michael
M
Felix
Juan C
JC
Lonky
Neal M
NM
Bentz
Joel S
JS
Marshall
C Jay
CJ
Cestero
Ramon M
RM
Rowe
Leslie R
LR
Lonky
Stewart A
SA
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*