Comparison of Cervix-Brush-Combi with Cervix- Brush for collection of cervical cells in Pap smear

Document Type : Original Article


1 Lecture of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 M.Sc. of Midwifery, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran.

3 Lecture of Biostatistics, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 Pathologist, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Introduction: Cervical cancer is one of the important health problems and one of the common gynecologic disease with high mortality rate. This study was performed with the aim to compare the Cervix-Brush-Combi with Cervix- Brush for collection of cervical cells in Pap smear.
Methods: In this quasi experimental study, 100 women referred to health care center No. 2 in east of Ahvaz were randomly divided into two group of code 1 (firstly, Cervix-Brush-Combi and then Cervix- Brush) and code 2 (firstly, Cervix- Brush and then Cervix-Brush-Combi). 200 samples were prepared from Endocervix and exocervix, and then, Brush's tip was removed from the trunk and was thrown into the vial with an alcohol base. After the closure of the vial, 20-15 times was shaken and sent to the laboratory. Data was analyzed by SPSS (version 16), and independent t-test and chi-square test. PResults: Mean number of exocervical and endocervical cells collected by Cervix-Brush-Combi were 63.3±48.0 and 636.3±545.5, respectively and collected by Cervix- Brush were 70.0±62.1 and 607.2±378.8, respectively. Independent t–test and chi-square test were not found significant difference between two tools.
Conclusion: Cervix-brush combi tool has the same efficiency and effectiveness in terms of collection of cervical cells compared to the cervix brush tool.


  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61(2):69-90.
  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2008; 127(12):2893-917.
  3. Tabeshian A, Firoozeh F. The Effect of Health Education on Performing Pap Smear Test for Prevention of Cervix Cancer in Teachers of Esfehan City. J Azad University Tehran Med Branc. 2009;19(1):35-40.[Persian].
  4. Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW. Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2011;61(1):8-30.
  5. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2012: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2012; 62: 129–42.
  6. Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H. Five common cancers in Iran. Arch Iran Med. 2010; 13(2):143-6.
  7. Khamechian T, Tabasi Z, Mazuchi T, Mesdaghinia A. A comparison of three pap smear collection methods.. sjsph 2006;4 (3):37-42.
  8. Dighe S, Ajit D. Collection devices for cervicovaginal cytology: a comparison. Acta Cytol. 2005;49(4):416-20.
  9. Davis-Devine S, Day SJ, Anderson A, French A, Madison-Henness D, Mohar N, et al. Collection of the BD SurePath Pap Test with a broom device plus endocervical brush improves disease detection when compared to the broom device alone or the spatula plus endocervical brush combination. Cytojournal. 2009;6:4.  
  10. Farimani M, Anvari N. Causes of Low Sensitivity of Papsmear Tests in Hamadan. Journal of Kermanshah University of Medical Sciences. 2007;10(4):359-67.
  11. Delavar M, Shafiq E, Mohammadpour R. Compare the effect of cervical brush and spachula on pap. Journal of Birjand University of Medical Sciences. 2006;13 (1):9-15 .[Persian].
  12. Martin-Hirsch P, Jarvis G, Kitchener HRL. Collection devices for obtaining cervical cytology samples (Review). The Cochrane Collaboration. 2000(3):CD001036.
  13. Asgharnia M, Heidarzadeh A, Akbarie E, Oudi M. Effect of cervical cleaning with cotton on quality of pap smear. Journal of Guilan University of Medical Sciences. 2006;15(58):41-7.
  14. Collection devices for cervical screening [Internet]. HSAC Report. 2008 [cited 20 Des 2013].
  15. van Ham MA, Siebers B, van Hamont DBRL, van de Laak J, Bulten J, et al. Cervical sampling with the Rovers®Cervex-brush results in significantly more endocervical cells and a higher detection rate of HPV 18 in the second half of the menstrual cycle 2007: Available from:
  16. Ngae MY, Crowder CD, Kjeldahl K, Gamez R, Paulson S, McKeon DM, et al. Broom versus broom-and-brush: a comparison of Surepath liquid-based Papanicolaou test (LBPT) collection devices. Cytojournal. 2009;6:20.
  17. Berek JS. Berek & Novak's Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012
  18. Davey D, Austin R, Birdsong G, Buck H, Cox J, Darragh T, et al. ASCCP patient management guidelines: Pap test specimen adequacy and quality indicators. Am J Clin Pathol. 2002;118:714-8.
  19. Martin-Hirsch P, Lilford R, Jarvis G, Kitchener HC. Efficacy of cervical-smear collection devices: a systematic review and meta-analysis. Lancet. 1999;354(9192):1763-70.
  20. Celik C, Gezginc K, Toy H, Findik S, Yilmaz O. A comparison of liquid-based cytology with conventional cytology. Int J Gynaecol Obstet. 2008;100(2):163-6.
  21. Davey E, Barratt A, Irwig L, Chan SF, Macaskill P, Mannes P, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review. Lancet. 2006;367(9505):122-32.
  22. Tsonev A, Ivanov S, Kovachev E. [Comparison of conventional PAP smear with liquid based cytology method (LBC)]. Akush Ginekol (Sofiia). 2012;51(7):20-4.
  23. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. The 2001 Bethesda System: Bethesda System: Terminology for reporting results of cervical cytology. JAMA. 2002; 287(16):2114-9.
  24. Depuydt CE, Benoy IH, Bailleul EJ, Vandepitte J, Vereecken AJ, Bogers JJ. Improved endocervical sampling and HPV viral load detection by Cervex-Brush Combi. Cytopathology. 2006;17(6):374-81.
  25. Cumming DA. Primary care procedures in women's health. S.M. Sulik and C.B. Health eds ed. USA: Sprnger sciences and bussiness medical; 2010.
  26. Etminan Bakhsh M, Farjad P. Comparison of cytology of cervicovaginal smears obtained by a broom with obtained by cotton-tipped swab and wooden spatula. Medical Sciences Journal of Islamic Azad University, Tehran Medical Branch. 2013;22(4):313-7.
  27. Bentz JS, Rowe LR, Gopez EV, Marshall CJ. The unsatisfactory ThinPrep Pap Test: missed opportunity for disease detection?. Am J Clin Pathol. 2002;117(3):457-63