title: The efficacy of two papanicolaou devices: a randomized study in a high-risk population.
abstract: OBJECTIVE
  Our goal was to determine the abil-ity of two Papanicolaou (Pap) smear devices to identify cor-rectly cervical intraepithelial neoplasia (CIN) in a high-risk population.
  
  
  METHODS
  Two hundred and seven nonpregnant women, referred to the colposcopy clinics at two University of Tennessee Family Practice Centers in Memphis and Jackson, were enrolled in the study if the referral Pap smear contained atypical cells of undetermined significance, a low-grade cervical intraepithelial lesion, or a high-grade intraepithelial le-sion. After they were randomly assigned to Pap smear with ei-ther the modified Ayre spatula and Cytobrush or the Acellon Combi brush, colposcopy and appropriate biopsies were per-formed in these women. Pap cytology and pathology results were compared using descriptive statistics and chi-square or Fischer's exact test.
  
  
  RESULTS
  Satisfactory Pap smears were ob-tained in 91 % of the Combi brush specimens and 100% of the Ayre spatula-Cytobrush specimens. Biopsies revealed that 85% of patients had CIN. Twenty-six percent of patients had CIN2 or CIN3. The sensitivities, specificities, and false-negative rates for the identification of any CIN were 69, 73, and 31% for the Ayre spatula-Cytobrush combination, and 72, 81, and 28% for the Combi brush, respectively.
  
  
  CONCLUSIONS
  The Ac-cellon Combi brush identified cervical disease as well as the spatula-Cytobrush combination in this high-risk population. The ability of a device to obtain endocervical cells did not cor-relate with its efficacy in identifying CIN.
authors.affiliation: *University of Tennessee, Jackson Family Medicine Residency Program, Jackson †University of Tennessee, St. Francis Family Medicine Residency Program, Memphis, Tennessee.
authors.forename: E
authors.initials: E
authors.lastname: Shaw
authors.forename: J E
authors.initials: JE
authors.lastname: Hamblin
authors.forename: M A
authors.initials: MA
authors.lastname: Murphy