CONTRIBUTION OF THE ENDOCERVICAL CYTOBRUSH SAMPLE TO THE DIAGNOSIS OFCERVICAL LESIONS

OBJECTIVE: To compare the contribution of endocervical Cytobrush sampl es to wooden spatula samples in the detection of cervical preneoplasti c lesions. STUDY DESIGN: Cytobrush sampling teas performed on 56,120 w omen in conjunction with ectocervical spatula sampling, resulting in t wo smears per patient. Almost all women with cytologic diagnoses of hi gh grade squamous intraepithelial lesions (CIN 3) or higher were biops ied. RESULTS: For the 221 CIN 3, the contribution of the endocervical sample was clearly more efficient, with diagnosis achieved on 98% of t he endocervical samples and on 62% of the ectocervical ones. In the 67 4 low grade squamous epithelial lesion cases, the endocervical samples were diagnostic in 79% of cases and the ectocervical smears in 64%. T hus, endocervical sampling proved to be superior in the recognition of precancerous lesions. In 93% of the 53 squamous carcinomas, cancer ce lls were found in both ectocervical and endocervical samples and in 7% , exclusively in endocervical smears. In 76% of the 21 adenocarcinomas , both samples were positive, and in 23% only the endocervical sample contained cancer cells. CONCLUSION: The Cytobrush samples were more ef ficient in the detection of intraepithelial neoplastic lesions, sugges ting that most of them originate in the endocervical epithelium. If th e sampling were limited to endocervical brushing, 14% of cervical lesi ons would not have been detected in the smear. The prominence of prene oplastic cells in the endocervical samples might indicate that the ori ginal glandular epithelium is the major site cervical carcinogenesis.