Use of a cervical brush for Papanicolaou smear collection. A meta-analysis.

Inadequacy of Papanicolaou smear specimens, specifically lack of endocervical cells, has been cited as a major reason why between 0.5% and 44% of cases of dysplasia are not detected by conventional screening tools. Of several sampling instruments devised and tested in an attempt to increase endocervical cell retrieval, one of the most promising in the last decade has been a cervical brush. Studies comparing the cervical brush to more conventional devices such as the spatula and cotton swab were examined in this review. A meta-analysis of these studies indicated a significant mean risk difference or increase in endocervical cell retrieval of 0.22 when the cervical brush was used either alone or in combination with a spatula compared to a spatula alone or with a cotton swab. Subpopulations such as pregnant or postmenopausal women, women with cervical stenosis, or women with a history of cervical surgery also showed significant mean increases in endocervical cell retrieval with the cervical brush. The evidence for whether use of a cervical brush actually increases detection of cervical dysplasia is less clear, although there appears to be a trend in that direction.