Comparison of the efficacy of the cervex brush and the extended-tip wooden spatula with conventional cytology: A longitudinal study

Background: Within the United Kingdom, the change from conventional to liquid based cytology (LBC) has brought with it the universal introduction of broom style samplers, as represented by the Cervex sampler. The aim of this study was to assess whether or not there were benefits associated with a change from wooden spatulae to broom style samplers for those countries where conversion to LBC might not be readily available or is not fully supported. Methods: A longitudinal study was designed to compare the performance of Cervex brushes and extended-tip wooden spatulae as sampling devices for conventionally prepared cervical smears. General Practices serving the population of Hull and East Yorkshire (UK) were provided with Cervex brushes for a period of nine months to routinely collect cervical smears. The results of 66,931 cervical smear tests were compared between those practices that were using extended-tip wooden spatulae before the trial and then returned to their use afterwards, and those who were previously using Cervex samplers and continued to use them throughout. Analyses comparing both specimen inadequacy, as recorded on the standard cervical screening request form (HMR101), and also the presence of identified transformation zone (TZ) elements in smears, both indicated significant advantages associated with the Cervex brush. Results: Inadequate smears decreased from 5.96% with extended-tip spatulae to 4.77% with Cervex brushes (p< 0.001) and increased back to 7.34% when practices reverted to extended-tip spatulae after nine months. Under the same conditions, the proportion of smears containing identified TZ elements increased from 50.52% to 54.75% (p< 0.001), before reverting to 45.47% (p< 0.001). In contrast, for a control group of practices using the Cervex brush throughout, inadequate smears decreased in all phases of the study, with no significant variation in TZ sampling rates. Conclusions: Using the Cervex brush with conventional cytology significantly decreases inadequate smears and increases TZ sampling when compared to the extended-tip spatula and can offer improved cervical screening in countries unable or unwilling to convert to LBC.