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| |  ACOG: Endocervical Brush as Effective as Endocervical Curette for Colposcopy Evaluation Following Abnormal Pap Test By Peggy Peck Special to DG News LOS ANGELES, CA -- May 7, 2002 -- The endocervical brush is more sensitive in detecting endocervical dysplasia than the endocervical curette, according to a prospective, randomized comparison study. Researchers reported the findings here yesterday at the 50th Annual Meeting of the American College of Obstetricians and Gynecologists (ACOG). According to their study, patients reported significantly less pain associated with the brush than with the curette. Dr. Shelly W. Holmström and colleagues from the Mercer University School of Medicine, Savannah, Georgia received the ACOG First Prize in Clinical Investigation Papers for the study. Many gynecologists have suggested that the endocervical brush should replace endocervical curette (ECC) for the evaluation of the cervical canal in patients undergoing colposcopy following abnormal Pap tests, she noted. "The ECC has been associated with a high false positive rate as well as significant patient discomfort,” she said. But she added, “there are currently no prospective studies to support this position." The investigators enrolled 148 women between September 1, 1999 and October 31, 2000, who were referred for evaluation of abnormal Pap tests. During the colposcopic evaluation samples were obtained from each woman using both the endocervical brush and ECC. Women were blinded to the order of the sampling technique. Seventy-seven women were assigned to ECC first, followed by endocervical brush and 71 women had endocervical brush sampling first and then ECC. The women were asked to rate their discomfort level using a visual 10 cm analogue scale with zero representing no pain and 10 cm representing extreme discomfort. Twenty-two of the women were found to have endocervical involvement and 14 women had disease confined to the ectocervix. "The sensitivity of the endocervical brush was 95.5 percent compared to ECC sensitivity of 59.1 percent with a p [value] of 0.0234," Dr. Holmström said. But the specificity of the brush was only 15.4 percent compared to a specificity of 50 percent for ECC (p=0.0512). In this study ECC identified pathology in five women that were not identified by brush, she said. The mean pain score for the endocervical brush was 1.31 compared to 3.52 for ECC and "this was highly significant with a p [value] less than 0.001," she said. Although ECC was more specific than the brush in this series, Dr. Holmström and colleagues concluded that their findings support the position that the endocervical brush "on the whole is as sensitive and specific as ECC, while causing significantly less pain for patients. Therefore, the brush should replace ECC."
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