Comparison of the Cervex-Brush alone to Cytobrush plus Cervex-Brush for detection of cervical dysplasia in women with a transformation zone type 3.

INTRODUCTION: Twenty percent of colposcopic assessments are inadequate due to a type 3 transformation zone (TZ3). In the absence of colposcopic or histological assessment, subsequent management is guided by the referral screening test. In the UK routine cervical screening is completed by a Cervex-Brush alone. This study examines the effectiveness of a cytobrush in addition to a standard Cervex-Brush when used in TZ3 assessment.

METHODOLOGY: An 18 month diagnostic accuracy study in a single NHS Trust. Women with a TZ3 booked for LLETZ with a referral cytology of high risk HPV and squamous dyskaryosis were recruited. Immediately prior to LLETZ a Cervex-Brush plus Cytobrush liquid-based cytology sample was taken. Presence of endocervical cells were compared. Predictability of CIN2+ was by blind standardised reporting of the LLETZ histology.

RESULTS: One hundred and five women were recruited from a total eligible population of 153 cases (68.8%). Endocervical cell yield was increased with the Cervex-Brush plus Cytobrush when compared to the Cervex-Brush alone (99.1% vs 79.1%, p<0.001). Irrespective of cytological grade, age or parity, there was no difference in predictability of CIN2+ between sampling methods CONCLUSIONS: When compared to Cervex-Brush sampling alone, the addition of a Cytobrush improves endocervical sampling but does not improve cytological predictability of CIN2+ in women with a TZ3. These data suggest that women who will reliably attend for cytological follow-up can be safely referred to primary care for a Cervex-Brush alone. This article is protected by copyright. All rights reserved.