EVALUATION OF THE CERVICAL CANAL WITH THE ENDOCERVICAL BRUSH

Objective: To evaluate and compare the cytologic information obtained from the endocervical brush and the histologic information obtained fr om the standard endocervical curettage (ECC) used to evaluate the endo cervical canal in patients with an abnormal Papanicolaou test. Methods : Three hundred eighty-eight patients underwent evaluation of an abnor mal Papanicolaou test with a repeat Papanicolaou test, a separate endo cervical brush test, colposcopy, directed biopsies, and ECC. The study group comprised 101 patients who subsequently underwent conization an d/or hysterectomy. The brush and ECC results were evaluated against th e final pathologic findings. Results: Sixty-five patients had a satisf actory colposcopy and 36 had an unsatisfactory colposcopy. Results for these two groups are reported separately. For the total group, the se nsitivities of the ECC and brush were 49 and 93%, respectively (P < .0 01); the specificities were 82 and 26% (P < .001), the positive predic tive values were 69 and 52% (P = .99), and the negative predictive val ues were 65 and 82% (P = .004). Conclusion: The endocervical brush app ears to be a sensitive test for disease in the endocervical canal but yields a high false-positive rate. The role of the brush in this setti ng will require further study. The ECC is more specific but is also a suboptimal test for identifying disease in the endocervical canal.