Spatula/cytobrush vs. spatula/cotton swab detection of cervical condylomatous lesions.

Human papillomavirus is widely implicated as a primary etiologic factor in cervical carcinoma. This study compared the sampling accuracy of the modified Ayre spatula/Zelsmyr cytobrush versus the modified Ayre spatula/cotton swab in the detection of cervical lesions with koilocytotic features. The histologic categories consisted of koilocytotic lesions (flat condylomas) with minimal cellular atypia and cervical intraepithelial neoplasia (CIN) I, II and III with surface koilocytes showing cellular atypia (atypical koilocytosis). Using the spatula/cytobrush there was 88% concurrence (118/134 cases) between the cytologic/histologic diagnosis of flat condyloma and CIN with atypical koilocytosis. Using the spatula/swab there was a cytologic/histologic concurrence of 68% (71/104 cases). Statistical analysis confirmed the difference between the two techniques to be significant. In addition, a higher percentage of CIN II and III lesions with koilocytotic features was detected with the spatula/cytobrush--54% (19/35 cases) as compared to 30% (14/46 cases) for the spatula/swab. The results of this study support the use of the spatula/cytobrush in the detection of cervical lesions with koilocytotic features.