Comparison of Endocervical Curettage and Endocervical Brushing

Abstract

This study compared the results of colposcopic evaluation of the endocervical canal with conventional endocervical curettage (ECC) or endocervical brushing performed using a new cervical sampling technique. Three hundred fifteen women with abnormal Pap smear results who were referred for colposcopy were randomly assigned to one of two endocervical sampling groups. An additional cervical smear was prepared for each study participant, and each underwent colposcopic evaluation, endocervical canal sampling, and punch biopsy. The endocervical brush technique uses a standard cytobrush. Ten to twelve swipes, each penetrating the length of the entire cervical canal, are made while rotating the brush to sample the complete surface of the canal. The brush is pressed between two layers of lens paper, as much of the specimen as possible is squeezed from between the bristles of the brush. The specimen is processed in the same way as ECC samples. The ECC is done with a Kevorkian curette using standard technique with care to avoid contamination from the exocervix. One hundred fifty-one patients in the ECC group and 154 in the brushing group were eligible for evaluation. The loop electrosurgical excision procedure (LEEP) was performed in all patients with extensive or high-grade squamous intraepithelial lesions, positive endocervical specimens, or inadequate colposcopy. One hundred forty-seven patients (76 in the ECC group and 71 in the brushing group) underwent LEEP. Histologic examination showed no evidence of disease in 138 of the 151 eligible patients in the ECC group and in 139 of the 154 eligible patients in the brushing group. Among the patients with positive results, 4 of 13 (30.8%) in the ECC group and 4 of 14 (28.6%) in the brushing group had false-positive results due to contamination of the specimen from lesions on the exocervix. Five patients in the ECC group and three in the endocervical brushing group had false-negative results indicated by histologic examination of samples obtained during LEEP. In the brushing group, 12 samples (7.8%) contained scanty tissue, compared with 4 (2.5%) in the ECC group. There was one inadequate sample in the brushing group and none in the ECC group. The frequency and amount of patient discomfort, as measured by the physician using the Present Pain Intensity Scale (median pain score = 1) and as reported by patients themselves (median pain score = 2), were statistically similar for both techniques. When the sensitivity and specificity of ECC and endocervical brushing for positive histologic results were measured, there were no statistically significant differences between the two groups (sensitivity: ECC = 64.3%, brushing = 76.9%; specificity: ECC = 97.1%, brushing = 97.2%). Negative and positive predictive values were very similar for both groups.