New fabric brush cuts low-quality endocervical sampling
Endocervical sampling with a new fabric-based curette device reduces the number of “inadequate” specimens and hence, the need for repeat biopsies compared with conventional metal scraping, reveals a recent study.
The new single-use, cone-shaped tip device uses fabric hooks, akin to the rough side of a Velcro tape, which trap tissues from the endocervical canal when the device is rotated or agitated inside the canal. This procedure has been shown to be less painful than the conventional cervical curettage (ECC) using a metal Kevorkian curette, which scrapes tissues off with its sharp tip for cervical cancer screening or HPV testing.
“The new device, on the other hand, is not sharp and removes the appropriate amount of cells while minimizing discomfort,” said Dr Justin Diedrich of University of California in Riverside, California, US. “We found that the new fabric devices had significantly fewer ‘inadequate’ specimens ─ meaning, patients did not need to return for repeat biopsies.”
Compared with the conventional ECC, significantly fewer specimens classified as “inadequate” were obtained with fabric ECC (4.2 percent vs 0.6 percent; p<0.001). Specimens classified as “limited” were also reduced with fabric ECC vs the conventional ECC (8.3 percent vs 11.2 percent). [J Low Genit Tract Dis 2017;21:304-306]
Using the fabric ECC, more “satisfactory” specimens were obtained than those using the conventional method (91.1 percent vs 84.6 percent).
“[T]here is a significant reduction in additional biopsies for these patients, as well as a decrease in unnecessary delays of diagnosis,” said Diedrich and co-authors.
Also, significantly more samples with high-grade dysplasia (grades CIN* 2 and above) were revealed with fabric ECC than with the conventional technique (3.9 percent vs 2.3 percent; p<0.01).
“Because the biopsy [with fabric-based ECC] gets more tissue, it is able to find more precancerous cells. This could be the difference between intervening early before someone develops cancer and waiting until it has grown larger,” said Diedrich.
The retrospective, case-control study involved patients who underwent ECC before and after the fabric-based ECC device was introduced. A total of 9,234 ECCs were performed using the standard metal curette while 774 ECCs were done using the fabric-based device.
Since there is a lack of standardization on the definition of “adequacy” in ECC sampling in available literature, the researchers noted that this might lead to variable reporting on adequacy between different studies. Nonetheless, the community setting in which the study was conducted “is representative of many community practices and improves generalizability”, according to the researchers.
“Innovation is making colposcopy less painful, gets a larger biopsy, and improves the detection of abnormal cells,” said Diedrich, noting that the single-use, fabric-based device also obviates the need for cleaning.
“Whenever someone has an abnormal Pap smear she should speak with her doctor about what the management options are,” he added. “If the patient needs a colposcopy to have her cervix looked at more closely, she should ask about ways to minimize discomfort.”