Objective: To find an appropriate sampling device for a liquid-based procedure in the population screening for cervical cancer, focusing on bleeding at sampling and the amount of cells smeared. Methods and Materials: 1,000 consecutive women who underwent primary screening were studied. The specimens were obtained with the cotton stick/Cytobrush® method in the first 500 cases or with the Cervex-Brush® in the following 500 subjects, and were processed using the Thinlayer Advanced Cytology Assay System (TACAS™) following the manufacturer’s instructions. Results: (1) Bleeding at cellular sampling using the cotton stick/Cytobrush and Cervex-Brush methods occurred in 1.2 and 8.8% of the cases, respectively (p < 0.0001). (2) The incidences of cells obtained with the two methods which covered the whole area, <1/2 and ≥1/4, and <1/4 of the observation fields were 55.4 versus 62.2% (p < 0.05), 14.6 versus 9.4% (p < 0.05), and 2.0 versus 4.0% (p < 0.05), respectively. (3) The incidences of endocervical or metaplastic cells obtained with ≥500 and <10 were 34.6 versus 20.0% (p < 0.01) and 9.4 versus 18.4% (p < 0.01), respectively. In cases of cells covering <1/4, incidences with <10 were 0 and 0.6% (n = 3), respectively. (4) Detection rates of abnormal cytology were 3.4 and 5.2% (n.s.), including atypical squamous cells of undetermined significance in 2.4 and 3.2%. Conclusions: The cotton stick/Cytobrush is superior to the Cervex-Brush as a cellular sampling device for the TACAS liquid-based procedure.

Namce KV: Evolution of Pap testing at a community hospital: a ten-year experience. Diagn Cytopathol 2007;35:148–153.
Akamatsu S, Himeji Y, Ikuta N, et al: Satisfactoriness and disease detection in the screening specimens of cervical cancer – comparison between liquid-based and conventional methods (in Japanese). Jpn J Clin Cytol 2008;47:420–424.
Hutchinson ML, Hutchinson ML, Isenstein LM, et al: Homogenous sampling accounts for the increased diagnostic accuracy using the ThinPrep® Processor. Am J Clin Pathol 1994;101:215–219.
Lee KR, Ashfaq R, Birdsong GG, et al: Comparison of conventional Papanicolaou smears and fluid-based, thin-layer system for cervical cancer screening. Obstet Gynecol 1997;90:278–284.
Hatch KD, Sheets E, Kennedy A, et al: Multicenter direct-to-vial evaluation of a liquid-based Pap test. J Lower Gen Tract Dis 2004;8:308–312.
Park J, Jung EH, Kim C, et al: Direct-to-vial comparison of a new liquid-based cytology system, liquid-PREP versus the conventional Pap smear. Diagn Cytopathol 2007;35:488–492.
Kuramoto H, Iwami Y, Sugimoto N, et al: Aplication of a new liquid-based procedure (TACAS) for the screening of cervical cancer: a preliminary study. Acta Cytol 2012;56:74–79.
Kuramoto H, Sugimoto N, Iida M: Screening of cancer of the cervix with simultaneous Pap smear and colposcopy – the efficacy of Pap smear and colposcopy. Eur J Gynaecol Oncol 2011;32:73–76.
Ferris DG, Berrey MM, Ellis KE, et al: The optimal technique for obtaining a Papanicolaou smear with the Cervex-Brush. J Fam Pract 1992;34:276–280.
Solomon D, Nayar R (eds): The Bethesda System for Reporting the Cervical Cytology, ed 2. New York, Springer, 2004.
Understanding the Reporting Method of Cervical Cytology Based on the Bethesda System (in Japanese). Jpn Soc Obstet Gynecol. Tokyo, Chugai Med, 2008.
New Standard Atlas of New Colposcopy (in Japanese). Jpn Soc Gynecol Oncol. Tokyo, Chugai Med, 2005.
Fokke HE, Salvatore CM, Schipper ME, et al: The quality of the Pap smear. Eur J Gynaecol Oncol 1992;13:445–448.
Boon ME, de Graaff Guilloud JC, Rietveld WJ: Analysis of five sampling methods for the preparation of cervical smears. Acta Cytol 1989;33:843–848.
Davey-Sullivan B, Gearhart J, Evers CG, et al: The Cytobrush effect on Pap smear adequacy. Fam Pract Res J 1991;11:57–64.
Neinstein LS, Church J, Akiyoshi T: Comparison of Cytobrush with Cervex-Brush for endocervical cytology sampling. J Adolesc Health 1992;13:520–523.
Marchand L, Mundt M, Klein G, et al: Optimal collection technique and devices for a quality pap smear. WMJ 2005;104:51–55.
Cannon JM, Blythe JG: Comparison of the Cytobrush plus plastic spatula with the Cervex Brush for obtaining endocervical cells. Obstet Gynecol 1993;82:569–572.
Paraiso MF, Brady K, Helmchen R, et al: Evaluation of the endocervical Cytobrush and Cervex-Brush in pregnant women. Obstet Gynecol 1994;84:539–543.
Dey P, Collins S, Desai M, et al: Adequacy of cervical cytology sampling with the Cervex brush and the Aylesbury spatula: a population based randomised controlled trial. BMJ 1996;313:721–723.
Martin-Hirsch P, Jarvis G, Kitcherner H, et al: Collection devices for obtaining cervical cytology samples. Cochrane Database Syst Rev 2000;3:CD001036.
Buntinx F, Brouwers M: Relation between sampling device and detection of abnormality in cervical smears: a meta-analysis of randomised and quasi-randomised studies. BMJ 1996;313:1285–1290.
Altematt HJ, Wyler K, Fravi R, et al: Cervix cytology: Cervex Brush versus conventional cotton swab. Praxis 1997;86:1029–1033.
Whitaker CJ, Stamp EC, Young W, et al: Comparison of the efficacy of the cervex brush and the extended-tip wooden spatula with conventional cytology: a longitudinal study. Cytojournal 2009;19:2.
Kavak ZN, Eren F, Pekin S, et al: A randomized comparison of the 3 Papanicolaou smear collection methods. Aust NZ J Obstet Gynecol 1995;35:446–449.
Davis-Devine S, Day SJ, Anderson A, et al: Collection of the BD SurePath Pap test with a broom device plus endocervical brush improves disease detection when compared to the broom device alone or the spatula plus endocervical brush combination. Cytojournal 2008;12:4.
Depuydt CE, Benoy IH, Bailleul EJ, et al: Improved endocervical sampling and HPV viral load detection by Cervex-Brush Combi. Cytopathology 2006;17:374–381.
Kothari A, Karim SZ, Gordon A, et al: A comparative study of two devices used for cervical cell sampling raises some doubts about liquid-based cytology. Int J Gynecol Cancer 2006;16:1579–1586.
Day SJ, O’Shaughnessy DL, O’Connor JC, et al: Additional collection devices used in conjunction with the SurePath Liquid-based Pap test broom device do not enhance diagnostic utility. BMC Womens Health 2004;13:6.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.