Improved endocervical sampling and HPV viral load detection by Cervex-Brush® Combi

Objective: Liquid-based cytology (LBC) for cervical screening is becoming increasingly used. Together with SurePath((R)) LBC, various collecting devices can be utilized, among which the Cervex-Brush((R)) is the most widely used. The new Rovers((R)) Cervex-Brush((R)) Combi combines the advantages of the Cervex-Brush((R)) with the EndoCervex-Brush((R)) increasing sampling of the endocervical canal. The objective of this study was to analyse and to compare the Cervex-Brush((R)) Combi with the Cervex-Brush((R)) for the collection of squamous and endocervical cells, human papillomavirus (HPV) typing/quantification and disease detection in SurePath((R)) LBC. Methods: Using either the Cervex-Brush((R)) or the Cervex-Brush((R)) Combi 100 consecutive SurePath((R)) LBC samples were collected using each brush type. All 200 slides were read by the FocalPoint(TM) and screened by guided screening using slide wizards. The viral load of HPV type 16 E7, 18 E7, 31 E6, 33 L1, 33 E6, 35 E4, 39 E7, 45 E7, 51 E6, 52 L1, 52 E7, 53 E6, 56 E7, 58 L1, 58 E6, 59 E7, 66 E6 and 68 E7 was determined using a TaqMan-based real-time quantitative PCR analysis. Results: The mean number of sampled squamous cells did not differ between the two brush types (54 963 versus 54 595 cells). The use of the Cervex-Brush((R)) Combi, however, resulted in a two- to threefold increase in the number of sampled endocervical cells (P < 0.00001). Using the Cervex-Brush((R)) Combi slightly more lesions were detected (three versus two low-grade squamous intraepithelial lesions), and resulted in the detection of more atypical squamous cells of undetermined significance (six versus three). In the Cervex-Brush (R) group, 60% (3/5) of abnormal smears were positive for oncogenic HPV types, whereas 66.7% (6/9) of abnormal smears in the Cervex-Brush((R)) Combi group tested positive. The median HPV viral load for samples taken with the Cervex-Brush((R)) Combi was 0.1825 copies/cell and was significantly higher than in samples taken with the Cervex-Brush((R)) (0.0042 copies/cell) (P = 0.02). Conclusion: Sampling with the Cervex-Brush((R)) Combi resulted in the collection of the same amount of squamous cells, but in a two to threefold harvest of endocervical cells. This led to the detection of a higher viral load for oncogenic HPV and an increase in the number of detected abnormal smears.