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An Abrasive Endometrial Cytologic Brush*
AN ABbiiVE
~At
OYTOLOGJO BBWB*
KENNETH SHELDON MACLEAN, M.D., NEw YoRK,
N.
Y.
~E puq~ose
of this commu:nication. is t~ describe an instrume~t for obtaincytologic exammatwn from the endocervrx, the endometrial cavity, the urinary bladder, and the other body eavities. 'J'he instrument consists of a speeially designed brush, a brush holder, and a shield.
T mg spemmens for
The brush has a twisted, rust-proof wire handle (Fig. 1) approximately 26 em. long and of such size as to render it :flexible and easy to insert into the brush holder (Fig. 2). The brush itself consists of a group of plastic or natural bristles of suitable stiffness, ap· proximately 5 em. long by 0.25 em. in diameter. The end of the brush is turned over so a~ to (1) prevent trauma from the sharp wire end, and (2) present bristles clear to the enu of the brush. The brush holder consists of a graduated hollow tube (Fig. 2) approximately 15 em. long and approximately 0.3 em. in diameter, with a polygonal handle (Fig. 3) at one end and a clamping device or chuck (Fig. 4), which also has a polygonal head. The chuck is drilled and split so that when screwed into the previously described handle it grips the wire stem of the brush firmly. The shield (Fig. 6) consists of a graduated tube 23.5 em. long by 0.4 em. in diameter, with one end bent up and rounded for ease of insertion and open for the passage of the abrasive brush. The diameter of the distal tnd is the same as that of the average ,uterine sound. The proximal end consists of a knurled head with a bayonet lock for use in attaching a Luer syringe or other commonly used aspirating apparatus. The brush is inserted through this. Mounted on the shield is an adjustable stop with a captive screw (Fig. 5) useful in regulating the depth of insertion of the shieltl into the uterine or other cavities. There il' also an adjustable arrangement (Fig. 7) mounted on the shield, containing an upright over which one ring of a Kahn's forceps, towel clamp, or other suitable instrument may be attached for holding the shield :firm while the hrush is being usetl. Fig. 8 shows the instrument ready for use on withdrawal of the brush into the shield. In use, the stem or wire handle of the brush is slipped through the tube of the brush holder until it reaches the bottom of the chuck, after which a single turn of the chuck with the fingers clamps (or releases) the brush as desired. The abrasive brush, in its holder, firmly gripped by the chuck, is then placed into the shield. After the cervix is exposed, the anterior lip is grasped with a Kahn's forceps or other suitable instrument and the shield with the brush is inserted through the internal os. The brush is then withdrawn into the shield and the brush with shield removed. 'l'he brush is again pushed out of the distal end of the shield and smears prepared, following which the bmsh is discarded.
Comment While present methods of diagnosis of cancer of the cervix give a high percentage of accuracy, yet the percentage of accuracy is not so high in other body cavities. The abrasive brush here described is so flexible, so obviously 1954.
*Presented at the Staff Conference, The Margaret Sanger Research Bureau, Jan. 22, 4.52
ABRASIVE ENDOMETRIAL CYTOLOGIC BRUSH
Volume 69 Number 2
453
harmless, that it can be used very effectively in certain cavities and certain parts of the body which, with present methods, lend themselves to limited investigation only. Despite the present-day emphasis on early cancer diagnosis, it is clearly impractical and unreasonable to recommend a dilatation and curettage in the case of every slight departure from the normal cycle. Furthermore, if the irregularity continues, despite a dilatation and curettage which proved negative, it is inadvisable to recommend or resort to repeated curettages. With the use of the abrasive brush, one may perform repeated cytologic testing, with minimum cost, discomfort, or fear to the patient, and minimum effort on the part of the physician. In addition, and what is especially important in the emotional, apprehensive, neurotic, or cancerophobic patient, the simplicity of the procedure permits the procuring of the specimen without the patient's hecoming aware of the purpose of the procedure . •• , ... JltiJ U
j.
pg•
l
il" V "W Wfi wp>J?F""P"'V""r!?tt!'"W"WW WP'WW WR FIGURE
CW
znun- namn
it& •
I
~================~=~ I FIGURE 3
FIGURE 2
fiGURE 5
I
FIGURE 4
FIGURE 7
FIGURE 8
The abrasive brush is inexpensive and disposable. Its use will eliminate many curettages, thus overcoming the objections of those who believe that curettages spread the disease. Furthermore, the shield can be used as a uterine sound, a urinary catheter, and a cannula for introducing gas or radiopaque material into the uterine cavity. Summary
1. A simple abrasive cytologic brush is described, useful m obtaining specimens from the uterine cavity for cytologic examination.
454
.\n,, 1, (){l..;r, & Gym~c
February,
195~
2. Abrasive cytologic brushes and devices are now in proeess of Jll·epa.ration*t to adapt the principle of the abrasive brush for use in obtaining specimens from many other body f'aYities anrl will h€ described in anothe1· eommunication. Grateful acknowledgment is accorded t.o Dr. M. J. Kopac, Professor of Biology at. New York University, and to his associate, Mr ..Jack Harris, Consultant on instrumentation, Washington Square College, New York University, and Consultant on instrumentation at Cytologic Institute for Cancer Research, New York City, for cooperation in the development and construction of these instruments, and to Mr. Ira Herlzberg of the H. Herlzberg & Sons Brush Company, New York City, for his generous cooperation in developing and supplying the many types of brushes used in the developmPnt of these instruments.
*Patents applied for. tAbraslve uevl<:ee .made. of. rubber -lll,ftd .:V.~- other C01Jl»>M4~I of _a~.l$1- ~- -~ _ln the process of exPerimentation and deVef6~. Re&tltts w1lf -tie t'ePOi'ted at il. ~· tillit-e.
~At
OYTOLOGJO BBWB*
KENNETH SHELDON MACLEAN, M.D., NEw YoRK,
N.
Y.
~E puq~ose
of this commu:nication. is t~ describe an instrume~t for obtaincytologic exammatwn from the endocervrx, the endometrial cavity, the urinary bladder, and the other body eavities. 'J'he instrument consists of a speeially designed brush, a brush holder, and a shield.
T mg spemmens for
The brush has a twisted, rust-proof wire handle (Fig. 1) approximately 26 em. long and of such size as to render it :flexible and easy to insert into the brush holder (Fig. 2). The brush itself consists of a group of plastic or natural bristles of suitable stiffness, ap· proximately 5 em. long by 0.25 em. in diameter. The end of the brush is turned over so a~ to (1) prevent trauma from the sharp wire end, and (2) present bristles clear to the enu of the brush. The brush holder consists of a graduated hollow tube (Fig. 2) approximately 15 em. long and approximately 0.3 em. in diameter, with a polygonal handle (Fig. 3) at one end and a clamping device or chuck (Fig. 4), which also has a polygonal head. The chuck is drilled and split so that when screwed into the previously described handle it grips the wire stem of the brush firmly. The shield (Fig. 6) consists of a graduated tube 23.5 em. long by 0.4 em. in diameter, with one end bent up and rounded for ease of insertion and open for the passage of the abrasive brush. The diameter of the distal tnd is the same as that of the average ,uterine sound. The proximal end consists of a knurled head with a bayonet lock for use in attaching a Luer syringe or other commonly used aspirating apparatus. The brush is inserted through this. Mounted on the shield is an adjustable stop with a captive screw (Fig. 5) useful in regulating the depth of insertion of the shieltl into the uterine or other cavities. There il' also an adjustable arrangement (Fig. 7) mounted on the shield, containing an upright over which one ring of a Kahn's forceps, towel clamp, or other suitable instrument may be attached for holding the shield :firm while the hrush is being usetl. Fig. 8 shows the instrument ready for use on withdrawal of the brush into the shield. In use, the stem or wire handle of the brush is slipped through the tube of the brush holder until it reaches the bottom of the chuck, after which a single turn of the chuck with the fingers clamps (or releases) the brush as desired. The abrasive brush, in its holder, firmly gripped by the chuck, is then placed into the shield. After the cervix is exposed, the anterior lip is grasped with a Kahn's forceps or other suitable instrument and the shield with the brush is inserted through the internal os. The brush is then withdrawn into the shield and the brush with shield removed. 'l'he brush is again pushed out of the distal end of the shield and smears prepared, following which the bmsh is discarded.
Comment While present methods of diagnosis of cancer of the cervix give a high percentage of accuracy, yet the percentage of accuracy is not so high in other body cavities. The abrasive brush here described is so flexible, so obviously 1954.
*Presented at the Staff Conference, The Margaret Sanger Research Bureau, Jan. 22, 4.52
ABRASIVE ENDOMETRIAL CYTOLOGIC BRUSH
Volume 69 Number 2
453
harmless, that it can be used very effectively in certain cavities and certain parts of the body which, with present methods, lend themselves to limited investigation only. Despite the present-day emphasis on early cancer diagnosis, it is clearly impractical and unreasonable to recommend a dilatation and curettage in the case of every slight departure from the normal cycle. Furthermore, if the irregularity continues, despite a dilatation and curettage which proved negative, it is inadvisable to recommend or resort to repeated curettages. With the use of the abrasive brush, one may perform repeated cytologic testing, with minimum cost, discomfort, or fear to the patient, and minimum effort on the part of the physician. In addition, and what is especially important in the emotional, apprehensive, neurotic, or cancerophobic patient, the simplicity of the procedure permits the procuring of the specimen without the patient's hecoming aware of the purpose of the procedure . •• , ... JltiJ U
j.
pg•
l
il" V "W Wfi wp>J?F""P"'V""r!?tt!'"W"WW WP'WW WR FIGURE
CW
znun- namn
it& •
I
~================~=~ I FIGURE 3
FIGURE 2
fiGURE 5
I
FIGURE 4
FIGURE 7
FIGURE 8
The abrasive brush is inexpensive and disposable. Its use will eliminate many curettages, thus overcoming the objections of those who believe that curettages spread the disease. Furthermore, the shield can be used as a uterine sound, a urinary catheter, and a cannula for introducing gas or radiopaque material into the uterine cavity. Summary
1. A simple abrasive cytologic brush is described, useful m obtaining specimens from the uterine cavity for cytologic examination.
454
.\n,, 1, (){l..;r, & Gym~c
February,
195~
2. Abrasive cytologic brushes and devices are now in proeess of Jll·epa.ration*t to adapt the principle of the abrasive brush for use in obtaining specimens from many other body f'aYities anrl will h€ described in anothe1· eommunication. Grateful acknowledgment is accorded t.o Dr. M. J. Kopac, Professor of Biology at. New York University, and to his associate, Mr ..Jack Harris, Consultant on instrumentation, Washington Square College, New York University, and Consultant on instrumentation at Cytologic Institute for Cancer Research, New York City, for cooperation in the development and construction of these instruments, and to Mr. Ira Herlzberg of the H. Herlzberg & Sons Brush Company, New York City, for his generous cooperation in developing and supplying the many types of brushes used in the developmPnt of these instruments.
*Patents applied for. tAbraslve uevl<:ee .made. of. rubber -lll,ftd .:V.~- other C01Jl»>M4~I of _a~.l$1- ~- -~ _ln the process of exPerimentation and deVef6~. Re&tltts w1lf -tie t'ePOi'ted at il. ~· tillit-e.