Comparison of endocervical curettage and endocervical brushing

Objective: To compare endocervical brushing with endocervical curettage wit h respect to diagnostic yield by histology and patient discomfort. Methods: Nonpregnant women referred for colposcopy because of abnormal Papa nicolaou test results were randomized to endocervical sampling with either a metal curette (endocervical curettage [ECC]) or an endocervical brush. Ex tensive endocervical canal brushing was performed. All samples were submitt ed for histologic study. Results were evaluated against the histologic find ings in electroconization specimens in a masked fashion. Pain scores were r ecorded using Melzack's Present Pain intensity Scale. Results: During the study period, 315 patients were randomized to the techn iques: 157 to ECC and 158 to endocervical brushing. Of the 315 patients, 14 7 also underwent electroconization. Overall false-positive rates were 28.6% for endocervical brushing and 30.8% for ECC False positives were due to co ntamination of the endocervical sample by lesional epithelium near the exte rnal os. The proportion of scanty specimens obtained by endocervical brushi ng (7.6%) was higher than that obtained by ECC (2.5%) (P = .041). One sampl e obtained by brushing was insufficient for diagnosis; none obtained by ECC were insufficient. There were no statistically significant differences in the median pain scores between the two groups. Conclusion: The techniques were similar in terms of diagnostic yield and pa tient discomfort. Endocervical brushing had lower false-positive rates than those reported in the literature for cytologic analysis. Although ECC rema ins the method of choice for evaluation of the endocervical canal, brushing is an acceptable alternative. (Obstet Gynecol 2000; 96:90-4. (C) 2000 by T he American College of Obstetricians and Gynecologists.).