Taking a sample for liquid based cytology (LBC)

Currently two LBC systems are used in the NHS cervical screening programme. Both use a plastic broom sampler (1).

Taking a sample:

• choose the appropriate speculum in order to visualize the whole cervix and to obtain a satisfactory sample
• the central bristles of a cervical brush is inserted into the endocervical canal making certain that the shorter outer bristles contact the ectocervix fully
• rotate the brush five times in a clock wise direction using pencil pressure

Taking an additional endocervical sample

• an endocervical brush can be used to obtain a second sample in the following instances:
  • inserting a cervical brush in to the os is difficult due to narrowing or stenosis
  • women who are followed up for
    • previous borderline changes in endocervical cells
    • previously treated endocervical glandular abnormality (who has not had a hysterectomy or radiotherapy) when the previous sample was inadequate due to absence of cervical cells
  • the endocervix brush should be entered gently in to the os (with the lower bristles remaining visible) and rotated clockwise through one whole turn
  • the endocervical brush sample should be taken after the cervical brush sample

Samples should be fixed immediately before withdrawing the speculum. One vial should be used to fix both the samples and on the cytology request form it should be clearly mentioned that two sampling devices have been used and the reason (1)

If a wide ectropian is present:

• samples should be collected using a cervical brush
• if required, a second brush can be used to sweep the transformation zone (in accordance with advice from the LBC equipment supplier)
• same vial should be used to fix both samples and in the cytology request form should mention the fact that two samples are present (1)

Reference:

• 1. NHS Cancer Screening Programmes 2006. Taking samples for cervical screening. A resource pack for trainers