Improving the yield of endocervical elements in a Pap smear with the use of the cytology brush.

A clinical trial assessed the efficacy of three different combinations of instruments for capturing endocervical elements when performing a Pap smear. The instrument combinations tested were: 1) the cytology brush and extended-tip wooden spatula; 2) moistened cotton swab and extended-tip wooden spatula; and 3) extended-tip wooden spatula and Ayre blunt spatula. Ninety-six eligible women seen for Pap smears were randomized to one of these three groups. In addition, two comparison groups were included to evaluate the effects of education about collection protocols and of strict protocol adherence. The cytology brush and extended-tip wooden spatula combination captured endocervical elements in 90.3% of Pap smears, compared to 66.7% for cotton swab and extended-tip wooden spatula, and 60.0% for Ayre spatula and extended-tip wooden spatula. The strict adherence to a collection protocol or education on tools and collection methods did not significantly increase the capture of endocervical elements. Widespread use of the cytology brush was introduced into the clinical setting after the study was completed and resulted in an increase to 80.1% capture rate for endocervical elements from a preexisting rate of 49.9%.