From the Guidelines
The cervical broom is the most recommended brush to use for a Pap smear, as it can effectively sample both the endocervix and the T-zone at the same time, with one collection scraping of the cervix. This is based on the American Cancer Society guideline for the early detection of cervical neoplasia and cancer, which suggests that the cervical broom can be used instead of the extended tip spatula and the endocervical brush, and can be used in pregnant women 1.
Key Characteristics of the Cervical Broom
- The long central bristles of the broom are inserted into the endocervical os while the broom is pressed against the cervix so that the outer bristles bend.
- The broom is then rotated in one direction for five complete rotations, as rotating in one direction and then the other is not recommended because it can result in loss of cells.
Proper Use and Handling
- The cervical broom can be used with conventional cervical cytology, as well as with liquid-based cervical cytology.
- For conventional cytology, the broom sample is smeared on a slide by stroking the broom on the usable surface of the slide from the label margin toward the other end of the slide.
- The sample is then quickly fixed with a spray fixative or by immersing the slide in 95% ethanol.
Advantages Over Other Methods
- The cervical broom provides more consistent and representative sampling of the cervical cells, resulting in fewer inadequate specimens and improved detection of abnormalities.
- It is a single-sampling device that can sample both the endocervix and the T-zone at the same time, making it a more efficient and effective option for Pap smears.
From the Research
Brush Options for Pap Smear
- The Cervex-Brush is a cervical cytologic sampling device used to collect endocervical and ectocervical cells 2.
- A study comparing the Cervex-Brush with the cytobrush/Ayres spatula combination found that the cytobrush/Ayres spatula combination was better in picking up endocervical cells than the Cervex-Brush 3.
Effectiveness of Different Brushes
- The Cervex-Brush was found to be effective in detecting abnormal cells, with a higher percentage of abnormal cells detected using a 1080 degrees and 1800 degrees rotation 2.
- The cytobrush/Ayres spatula combination was found to be superior to the Cervex-Brush alone in producing adequate Pap smears 3.
Other Screening Methods
- HPV self-sampling is a proposed method that can mitigate socioeconomic disparities, reduce embarrassment and costs of screening, and has been found to be comparable to clinician-collected samples in terms of HPV detection rates and sensitivity 4.
- The combination of PAP smear and HPV testing has been found to offer clear advantages over single cytology in monitoring women conservatively treated for cervical AIS 5.
Pap Smear Detection
- Cervical Pap smears can be useful in detecting endometrial carcinomas, especially in cases with type 2 endometrial carcinomas, tumor with cervical involvement, and/or advanced FIGO stage 6.