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Endometrial sampling: brush less painful than curette. (Equivalent Quality).

LOS ANGELES -- The endocervical brush is less painful than a metal curette for endocervical sampling at colposcopy in patients with abnormal Pap smears, Dr. Shelly W. Holmstrom said at the annual meeting of the American College of Obstetricians and Gynecologists.

In a prospective, randomized comparison of the two tools in 148 women, mean pain scores as rated by the patients were significantly lower for the brush than the curette. Moreover, sample quality was similar for both methods when compared with pathology results in 41 patients who underwent cervical conization, she reported. The study won first prize at the meeting for papers by junior fellows.

Study participants were referred for evaluation after an abnormal Pap smear result during a 2-year period at Dr. Holmstrom's institution, Mercer University in Savannah, Ga. All women underwent colposcopy, and endocervical samples were taken twice. To obtain the samples, clinicians used the curette and then the brush in 77 women. In the remaining 71 women, they used the brush before the curette. Patients were randomized to the two groups and not told the order in which the instruments were used. The study excluded patients with a history of cervical cancer.

Patients rated the pain associated with each technique on a visual analog scale immediately after each sampling. On a pain scale of 0-10, with 10 representing the greatest pain, the brush earned a mean score of 1.30, and the curette scored a 3.65, Dr. Holmstrom said.

The only other study that has explored the degree of pain associated with the brush and curette found similar levels of discomfort and diagnostic yields. However, the 315 participants in that study had been randomized to undergo sampling using only one of the two tools, and they rated them after the colposcopic examination instead of immediately after the sampling (Obstet. Gynecol. 96[1]:90-94, 2000).

In the current study, the endocervical brush was 100% sensitive and 31% specific in detecting diseased cells, while the curette had a sensitivity of 70% and a specificity of 54%. The positive predictive values were 75% for the brush and 76% for the curette, and the negative predictive values were 100% for the brush and 47% for the curette.

Conizations found ectocervical and endocervical dysplasia in 26 patients, ectocervical lesions alone in 14 patients, and endocervical dysplasia alone in 1 patient, with results equally distributed between the brush and curette groups.

There was no significant difference between the two groups in the detection of endocervical dysplasia, results that echo the findings of seven previous studies of diagnostic yields with the brush or curette.
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Author:Boschert, Sherry
Publication:OB GYN News
Date:Jul 1, 2002
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