Endocervical sampling using brush versus curette: a single centre experience and literature review

Figures & data

Figure 1. Endocervical brush (left) and Kevorkian curette (right) (Figure 1).

Figure 2. PRISMA 2020 flow diagram (Page et al. 2021).

Table 1. Patient demographics.

	Curette (n = 117)	Brush (n = 95)
Age (mean ± std)	42.4 ± 11.6	41.4 ± 11.0
Gravidity (mean ± std)	2.2 ± 1.8	1.9 ± 2.0
Parity (mean ± std)	1.4 ± 1.3	1.3 ± 1.4
Nulliparous n (%)	40 (34.2%)	35 (36.8%)
Menopausal n (%)	36 (30.8%)	25 (26.3%)
Smoking n (%)
Yes	14 (12.0%)	18 (18.9%)
No	88 (75.2%)	69 (72.6%)
Unknown	15 (12.8%)	8 (8.4%)
Contraception n/total (%)
OCP	25 (21.4%)	16 (16.9%)
IUD	17 (14.5%)	12 (12.6%)
Other	50 (42.7%)	36 (37.9%)
Unknown	25 (21.4%)	31 (32.6%)
Pap test n (%)
Done	117 (100%)	92 (96.8%)
None	0 (0%)	3 (3.2%)
Pap test result n/total (%)
Negative	76 (66.1%)	52 (56.5%)
Endometrial	1 (0.9%)	1 (1.1%)
ASCUS	8 (7.0%)	8 (8.7%)
ASC-H	3 (2.6%)	3 (3.3%)
AGC	1 (0.9%)	2 (2.2%)
LSIL	17 (14.5%)	7 (7.6%)
HSIL	11 (9.4%)	19 (20.7%)
HPV Status n (%)
Positive	32 (27.3%)	25 (26.3%)
Negative	26 (22.2%)	15 (15.8%)
HPV Vaccination n (%)
Yes	18 (15.4%)	18 (18.9%)
No	1 (0.8%)	5 (5.3%)
Unknown	93 (79.5%)	43 (45.3%)
Prescribed	5 (4.3%)	29 (30.5%)
Adequate colposcopy n (%)
Yes	26 (20.5%)	37 (37.8%)
No	30 (23.6%)	31 (31.6%)
Not recorded	71 (55.9%)	30 (30.6%)

n: number; std: standard deviation; OCP: oral contraceptive pill; IUD: intra-uterine device; HPV: human papillomavirus.

Table 2. Histopathological findings of endocervical curetting obtained with endocervical brush vs. curette.

	Brush (n = 98)	Curette (n = 127)	p Value
Sufficient tissue	94 (95.9%)	124 (97.6%)	p = 0.46
Insufficient tissue	4 (4.1%)	3 (2.4%)
Histopathological Diagnosis			p = 0.28
Negative	88 (89.8%)	117 (92.1%)
SONE	2 (2.0%)	0 (0%)
LSIL	0 (0%)	1 (0.8%)
HSIL	3 (3.1%)	6 (4.7%)
AIS	1 (1.0%)	0 (0%)
Biopsy pathology	Brush (n = 47)	Curette (n = 79)	p = 0.43
LSIL or benign	38 (80.9%)	65 (82.3%)
HSIL, AIS or malignant	8 (17.0%)	14 (17.7%)
No tissue	1 (2.1%)	0 (0%)

Data are numbers (%). SONE: Strips of squamous neoplastic epithelium; HSIL: High-grade squamous intraepithelial; LSIL: Low-grade squamous intraepithelial lesion; AIS: adenocarcinoma in situ.

Table 3. Literature review of studies comparing endocervical brush (ECB) and endocervical curette (ECC) techniques.

First Author	Year	Country	Type of study	N	Comparison type	Results	Favour ECB/ECC
Mitric	2021	Canada	Retrospective	225	ECB vs. ECC	Adequate sample: 95.9% ECB, 97.6% ECC	Either
Bestel (Bestel et al. 2019)	2019	Turkey	Retrospective		ECB vs. ECC	Moderate amount of agreement between methods with intraclass correlation coefficient of 0.503 (95% CI 0.327-0.633)	ECB
Undurraga (Undurraga et al. 2017)	2017	Switzerland	RCT	190	ECB vs. ECC	Easy technique: 94.1% ECB, 61.4% ECC* Pain perceptions by physician: little/ not uncomfortable 28.7% ECB, 10.2% ECC*. Inadequate samples: 2.0% ECB, 14.3% ECC*	ECB
Goksedef (Goksedef et al. 2013)	2013	Turkey	RCT blinded	208	LSIL cytology: ECB vs. ECC	Insufficient sample: 9.6% ECC, 12% ECB VAS pain scores 2.55 ECC vs 1.99 ECB*	Either
Maksem (Maksem 2006)	2006	USA	Retrospective	1824	Compared highest histological dx: ECB + bx vs. ECC + bx	LSIL cytology and Dx CIN2+: 16.8% ECB + bx, 9.2% ECC + bx HSIL cytology and Dx CIN2 + L 72.2% ECB + bx, 63.7% ECC + bx	ECB
Gibson (Gibson et al. 2001)	2001	USA	Retrospective	547	ECB vs. ECC vs. ECB + ECC	Insufficient sample: 9.1% ECB, 1.7% ECC, 1.6% both	ECC
Klam (Klam et al. 2000)	2000	Canada	RCT	315	ECB vs. ECC	FP: 28.6% ECB, 30.8% ECC Sen: 76.9% ECB, 64% ECC. Spec: 97.2% ECB, 97.1% ECC Scant specimen: 7.6% ECB, 2.5% ECC* Insufficient sample 0.6% ECB, 0% ECC.	Either
Tate (Tate and Strickland 1997)	1997	USA	RCT	124	ECC vs. ECC + ECB	Insufficient sample: ECC alone 10.3%; 0% ECC + ECB*	Both

N: number; RCT: randomised controlled trial; Bx: biopsy; LSIL: low-grade squamous intra-epithelial lesion; ECB: Endocervical brush; ECC: Endocervical Kevorkian curette; *statistically significant difference; Sen: sensitivity; Spec: specificity; NPV: negative predictive value; PPV: positive predictive value.

Table

#	Query	Results from 9 Aug 2022
1	((endocervi* or endo cervi*) adj2 brush*).ti,ab,kf.	136
2	(cytobrush* or cyto brush* or cervex).ti,ab,kf.	1,018
3	or/1–2 [Endocervical Brush]	1,128
4	((endocervi* or endo cervi*) adj2 curett*).ti,ab,kf.	901
5	3 and 4 [ECB vs ECC]	44
6	((endocervi* or endo cervi*) adj2 (sampl* or specimen* or evaluation* or collect*)).ti,ab,kf.	1,059
7	5 or 6 [General Endocervical sampling with ECB vs ECC]	1,077
8	colposcopy/	14,343
9	colposcop*.ti,ab,kf.	13,478
10	or/8–9 [Colposcopy]	17,652
11	7 and 10	162

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