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A Stiff Bristled, Spiral-Shaped Ectocervical Brush: A Device for Transepithelial Tissue Biopsy

From the Departments of Gynecologic Oncology, and Obstetrics and Gynecology, University of California at Irvine, Irvine, California; Clinical Pathology and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Anaheim, California; Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Department of Women’s Health, Arrowhead Regional Medical Center, Colton, California; Institute for Clinical and Experimental Pathology, Associated Regional and University Pathologists Inc., Salt Lake City, Utah; Department of Medicine, University of California at Los Angeles, Los Angeles, California; and The Trylon Corporation, Torrance, California.

Address reprint requests to: Stewart A. Lonky, MD, The Trylon Corporation, 970 West 190th Street, Suite 850, Torrance, CA 90502; E-mail: slonky{at}tryloncorp.com.

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.

CONCLUSION: 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.