June 17, 1958
`
`K. S. MaCLEAN
`
`Filed March 25. 1954
`
`ABRASIVE CYTOLOGIC BRUSH
`
`92
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`839,049
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`2 Sheets—Sheet 1
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`June 17, 1958
`
`K. S. MaOLEAN
`
`ABRASIVE CYTOLOGIC BRUSH
`
`Filed March 25, 1954
`
`2,839,049
`
`2 Sheets—Sheet 2
`
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`United States Patent Office
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`2,839,049
`Patented June 17, 1958
`
` 1
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`2,839,049
`
`ABRASIVE CYTOLOGIC BRUSH
`
`Kenneth S. MacLean, New York, N. Y.
`
`Application March 25, 1954, Serial No. 418,551
`14 Claims.
`(Cl. 128—2)
`
`The present invention relates, in general, to cytology,
`and, in particular,
`to an instrument for removing cells
`by abrasion from various parts of a patient’s body.
`In attempting to diagnose a patient for the presence
`of cancer, it is a well known practice to use a curette to
`obtain a tissue specimen of the suspected part of the
`patient’s body for study and examination. However,
`this procedure could be quite dangerous in that if cancer
`is present, the cancerous tissue may be cut into and, as
`a result thereof, cancer cells may enter the blood and/or
`lymphatic circulations and spread throughout the body.
`According to the procedure of exfoliative cytology de-
`veloped by Papanicolou, this danger may be avoided.
`In
`the practice of- the latter procedure, cells are removed by
`aspiration for laboratory study and examination for de-
`termining whether or not they are cancerous. However,
`the Papanicolou procedure does not provide for a positive
`removal of the cells since it depends upon the existence
`of surface cells which have exfoliated from a part of the
`body and can be removed by aspiration from the body.
`In view of the foregoing, the primary object of the pres-
`ent invention is to provide a means for obtaining for
`examination cells from a suspected part of the patient’s
`body which means provides for a positive removal of the
`cells from the body tissure while obviating the danger
`of cutting into cancerous tissue.
`Another object
`is to provide a cytologic instrument
`for the removal, by an abrasive procedure, of surface
`cells from an internal part of the patient’s body.
`Another object is the provision of an abrasive cytologic
`instrument whereby the cells which have been removed
`from an internal body part, are prevented from being
`lost or rubbed off by contact with the patient’s body
`during their removal from the patient’s body.
`A further object is the provision of an abrasive cytologic
`brush wherein the brush member is expendable so that
`a new brush can be provided for each patient, or separate
`brushes can be provided for obtaining cell specimens
`from different parts of the patient’s body.
`A still further object is the provision of an arrange-
`ment to facilitate the manipulation of a cytologic instru-
`ment within the patient’s body.
`The above and other objects, features and advantages
`of the present invention will be more fully understood
`from the following description considered in connection
`with the accompanying illustrative drawings.
`In the drawings, which illustrate the best mode pres-
`ently contemplated by me of carrying out the invention:
`Fig.
`1
`is a side View of an abrasive cytologic brush,
`pursuant
`to the present
`invention,
`for obtaining cell
`specimens from a patient’s uterus or womb,
`the brush
`member thereof being illustrated in its operative disposi-
`tion after insertion of the instrument into the patient’s
`body;
`. Fig. 2 is a longitudinal sectional View, on an enlarged
`scale, taken on the line 2—2 cf Fig. 1;
`Fig. 3 is a fragmentary View, similar to Fig. 1, of the-
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`the handle
`handle end of the abrasive cytologic brush,
`being illustrated in a retracted position thereof;
`Fig. 4 is a cross-sectional View, on an enlarged scale,
`taken on the line 4—4 of Fig. 2;
`Fig. 5 is a sectional view on an enlarged scale taken
`on the line 5—5 of Fig. 2;
`,
`Fig. 6 illustrates the abrasive cytologic brush in an
`operative disposition thereof relative to the patient’s body
`which is illustrated more or less diagrammatically;
`Fig. 7 is a side view of a laryngeal abrasive cytology
`brush pursuant to the present invention; and
`Fig. 8 is a longitudinal sectional view, on an enlarged
`scale, taken on the line 8—8 of Fig. 7.
`Referring now to Figs. 1—6 in detail, there is illustrated
`an abrasive cytologic brush or cytologic instrument 10
`for obtaining cell specimens from a patient’s womb or
`uterus. Briefly described,
`the instrument 10 comprises
`a brush holder 12, a brush member 14 releasably secured
`to the brush holder, and a shield 16 within which the
`brush holder 12 is disposed for relative movement.
`As here shown, the brush holder 12 is constituted by
`an elongated tubular member 18 preferably formed'of
`stainless steel or other suitable material and provided at
`one end thereof with a handle 20 which is preferably
`force—fit about said member at one extremity thereof.
`It will be noted that the handle extends outwardly be-
`yond the adjacent end of the tubular member 18 and is
`provided with a bore 22 which communicates with the
`hollow center of the tube 18.
`In order to releasably secure the brush member" 14
`within the tubular holder 12, provision is made for a
`brush retaining means, here constituted by the chuck 24.
`As here shown,
`the chuck 24 is constituted by a split
`collet 26 which is provided with a head or finger piece
`28. The collet 26 is provided with an externally threaded
`portion 25 for threaded engagement within the internally
`threaded bore 22 of the handle 29. The collet is also
`provided with a tapering portion 30 constituted by the
`split segments 32 which are defined by the splits 34. An
`opening or bore 36 (Fig. 4) is provided in the chuck for
`the insertion of one end of the stem 38 of the brush
`member 14. The bore 22, in the handle 20, is provided
`with an unthreaded tapering portion or clamping surface
`(it) which is complementary to the split segments 32.
`From the foregoing, it will be understood that the head
`28 of the {chuck 24 may be rotated in a counter-clockwise
`direction, viewing Fig. 6 to retract the chuck from the full
`line position thereof illustrated in Fig. 2 for withdrawing
`the split segments 32 from the brush clamping disposition
`thereof to release the stem 38 of the brush member 14.
`Actually only a few turns of the head 28 are required for
`the release of the brush stem 38. With the chuck 24 in
`said partially retracted position thereof, the stem 38 of
`another brush 14 may [be inserted into the opening 36,
`which is in registry with the bore in the tubular member
`18, and the head 28 may then be rotated in a clockwise
`direction for urging the chuck 24 into the handle 20, the
`split segments 30 being forced together by the tapering
`bore portion 40 resulting in the clamping of the brush
`stem 38 in the chuck 24, to releasa’bly secure the brush
`member 14 to the brush holder 12.
`As here shown, the brush member 14 is provided with
`the previously mentioned elongated stem 38 which is pref—
`erably formed of twisted zinc coated steel wires. At the
`end thereof opposite the end which is releasably secured
`in the chuck 24, the stem 38 is provided with the brush
`bristles 42 which may be formed of either natural or syn-
`thetic material. The bristles extend in all directions from
`the stem. At the bristled end thereof, the stem 38 is capped
`with a cap 44 preferably formed from a suitable smooth
`plastic material.
`It will be understood that the brush'
`3
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`2,839,049
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`member 14 is expendable, serving for only a single patient-
`use after- which it is discarded.
`~
`-
`The shield 16 is an elongated tubular member prefer—
`ably formed of stainless steel.
`’At one end thereof, the
`shield 16 is providedwith- a- knurled head or finger portion
`41, and at the other end thereof the shield is provided with
`a slight curvature or arcuate portion, as indicated at 43,
`to facilitate the passage thereof through the vaginal canal
`into the uterus or womb of the patient. The shield 16 is
`provided with an adjustable collar or detent member 46
`which is slidably movable longitudinally thereof and
`which is. provided with a knurled set screw 48 to releas-
`ably secure the detent in adjusted position longitudinally
`of the shield 16. The detent 46 serves to limit the extent
`of entry of the instrument 10 into the patient’s body,
`which‘is indicated at P in Figs. 2 and 6. Provision is also
`made on the tubular shield'16 for an additional adjustable
`_ collar 52 which is slidably movable longitudinally thereof
`and which is provided also with a knurled set screw 54
`for adjustably securing the collar 52 in position longitudi-
`naJl‘y of the shield. The collar 52 is additionally provided
`with an extending arm or element 56,
`the function of
`which will presently appear.
`As previously indicated, with the chuck 24 partially re-
`tracted 'fi'om its full—line position in Fig. 2, the brush 14
`may-be readily secured to the tubular brush holder 12 by
`inserting the stem 38 through the curved end 43. of'the
`shield into the holder 12 and through the latter into the
`chuck opening 36‘defined by split segments 32. The
`chuck is then rotated in a direction for axial movement
`thereof into the handle 20 to clamp the end of the stem
`into the holder through the cooperating action of the
`tapered bore portion 40 in the handle and the split seg-
`ments 32.
`,The head. 41- of the shield 16 may then be
`grasped in one. hand and the handle 20 of the brush holder
`12. may Ebe grasped in the other hand, for pulling the handle
`20 outwardly of the, shield, as indicated by the arrow 58
`in Fig. 1, to withdraw the bristles42 into the shield so as
`not to. project therefrom. The detent 46 is then adjusted
`longitudinally of the shield 16 to accommodate the par—
`ticular patient.
`It will be understood that the handle 20
`will nowbe retracted from the finger piece 42' to expose a
`substantial length of holder tube 18. The latter may be-
`suitably graduated or indexed as indicated :‘by the spaced
`lines or markings 66 (Fig. 3) which are preferably cali-
`brated in centimeters.
`In order to facilitate the insertion of the abrasive cy-
`‘ tologic brush 10 into the uterus or womb, a forcep or
`body-grasping instrument 60 (Fig. 6) may first be inserted
`through the vaginal canal, to grasp the cervix, as illustrated
`more or less diagrammatically in Figure 6. While retain-
`ing the hold on the cervix, the abrasive cytologic brush 10
`isthen inserted through the vaginal canal into the uterus
`or womb, the insertion thereof being limited by the abut-
`ment of the detent 46 against the patient’s body P. The
`previously mentioned collar 52 is then adjusted until the
`arm 56 thereof is in position to engage into either of the
`finger-openings 62 of the forcep, or within the opening 64
`thereof. This interengagement of both instruments will
`serve to steady and support the instrument 10 during the
`use thereof. The doctor may now grasp both the instru—
`ment 10 and the forcep 60 in the same hand, and with the
`other hand he may grasp the handle 20 and urge the latter
`inwardly of the instrument It), as from the broken line
`position thereof illustrated in Fig. 6 to the full line posi-
`tion thereof resulting in the movement of the bristles 42
`to a position outwardly of the shield 16 and within the
`womb, as in Fig. 6, The graduations 66 will indicate the
`extent of penetration of the bristles, 42 into the womb or
`Uterus.
`It will be noted that during said movement of the
`brush member 14 into the womb, outwardly of the shield
`16, the substantially rigid holder 12 serves the function of
`constituting a guide for the comparatively more flexible
`wire. stem 38 as well as serving as a holder for the brush.
`The brush member may be manipulated within the womb
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`by rotation of the holder handle 20 in opposite directions
`to rotate the brush bristles to and from the full lines and
`broken line positions thereof illustrated in Figure 2. This
`causes the bristles to'rub against the surfaces of the womb
`so as to elfect a positive removal by abrasion, of cells .
`from the womb tissue on to the bristles.
`'
`,
`.An important feature of the present invention resides in
`the fact that the cells, which have been removed from the
`body tissue by the bristles 42, can be removed from the
`patient-’3 body without 3being rubbed off the bristles by con-
`tact with the patient‘s body during removal of the instru-
`ment 1%.
`In this connection, the handle 20 of the brush: '
`holder 12 is now moved in the opposite direction, namely
`from the full line to the broken line position thereof,- as
`in Fig. 6, to withdraw or retract the bristles 42 completely
`into the shield 16.
`'The arm 56 of the collar 52 is now
`disengaged from the forcep 60 and the-entire instrument» .
`10 is withdrawn from the patient’s body. . The brush 14,
`'
`provided with the cell specimens which have been re—
`moved from the body, may now be readily removed from
`the instrument 10 by returning the handle 20 to the full
`line position. thereof, to a point where an unbristled por-
`tion of the stem 38 projects from the shield 16, as in Fig.
`2. This unbristled portion of the stem may then. be
`grasped and the chuck head 28 rotated a few turns to par-
`tially retract the chuck for releasing the stem from the
`holder.
`_
`-
`While the shielded abrasive cytologic brush 10 has been
`illustrated andfdescribed in connection withits use for
`removing cells or specimens from the uterus or womb,
`it will be understood that the present invention is-not
`limited for use in the specificallyrdescribed body part cr‘
`cavity.
`It iswithin the scope. of the present invention to
`provide a shielded abrasive cytologic brush: for other '
`body passages or cavities. For example and not byway
`of limitation, a shielded abrasive cytologic brush can be
`used ifor'insertion into the nasal. passages, urinary bladder,
`rectum, sigmoid colon, bronchus, oesophagus, stomachy
`peritoneal cavity, etc., it being understood that the shield
`16 would be provided, in each case, with the proper curva-
`ture or shape to accommodate the specific passage, and ,
`that the instrument would be dimensioned to accommo-
`date the spechic passage.»
`In any case,
`the shield 15.
`would facilitate the entry of the instrument into the par-'
`ticular body passage and would. serve to prevent the loss
`of the cells or specimens, by body contact, during the
`Withdrawal of the instrument item the body;
`,
`Referring now toFigs. 7 and 8 in detail, there is illus-
`trated an embodiment of the present invention for use in a .
`body passage or opening of such size as to obviate the
`necessity for the previously described shield in view of "
`the fact that the size of the body opening is large enough
`to permit the withdrawal of the brush therefrom without
`contacting adjacent parts of the body. More specifically,
`the present embodiment illustrates a laryngeal abrasive
`cytologic brush 70.. As hereshown, the cytologic instru-
`ment 70 is constituted bya brush holder 72, Which'is
`substantially similar to the previously described brush
`' holder 12, and by a brush member 74, which is substan-
`tially similar to the previously described brush member
`14. The brush holder 72 is constituted by an elongated
`tubular member 76 preferably formed of stainless steel,
`and provided at one end with a handle 78 which is pref-
`erably force fit thereon. The handle 78 isprovided with
`the previously mentioned chuck 24, which cooperates in
`the previously described manner with a handle bore 22
`having a tapering portion 40, to releasably secure the
`stem 38 of the brush member 74 in the brush holder 72.
`While in the previously described embodiment, the brush
`holder 12 was a straight or linear member, with substan-
`tially no curvature therein, the brush holder 72 is spe-
`cifically designed for insertion through the larynxihto
`the trachea, and for this purpose is provided with the
`arcuate portion 80 from which the bristles 42 of the brus >
`74. project.
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`2,839,049
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`While grasping the handle 78, the laryngeal cytology!
`brush 70 may be readily inserted into the larynx and
`trachea of the patient and manipulated therein so that
`the bristles 42 will rub or abrade the adjacent tissue sur-
`faces to remove surface cell specimens therefrom. The
`instrument 70 is then Withdrawn from the patient’s throat
`and, due to the relative diameters of the instrument 70 and
`the laryngeal and tracheal openings, there is no danger of
`the bristles 42 rubbing against adjacent body tissues during
`the removal of the instrument 70. As in the previously
`described embodiment 10,
`the brush 74 of the present
`embodiment is also expendable, a new brush member
`being used with each patient. The brush may be readily
`removed from the instrument, as previously described, by
`a partial retraction of the chuck 24, only two or three
`turns thereof being necessary, and a new brush may then
`be inserted into the holder 72, the stem 38 thereof being
`in automatic registry with the opening in the chuck 24
`when inserted into the shield 72. The chuck is then
`tightened to securely retain the brush in the holder 72.
`It will be noted that in the present embodiment,
`the
`holder 72, in addition to its function in holding the brush
`for the insertion thereof into the patient’s body, also
`serves as a guide for the brush, since, as previously indi-
`cated, the holder is substantially rigid and the stem 38
`is comparatively flexible, relative thereto.
`The shield 16 of the cytologic instrument 10 can be
`used as a cannula or catheter for injecting carbon dioxide
`or radio opaque substances into body cavities. For ex-
`ample, and not by way of limitation, the shield 16 above
`can be inserted into the uterus and the head 43-1 thereof
`connected by a tube to a tank of carbon dioxide for de~
`termining whether body passages leading to and from the
`uterus are blocked. Similarly, with the shield inserted
`in the uterus, radio opaque substances can be inserted
`through the open head 41 thereof into the uterus for
`taking X-rays.
`While I have shown and described the preferred em-
`bodiments of my invention, it will be understood that
`various changes may be made in the present invention
`Without departing from the underlying idea or principles
`of the invention within the scope of the appended claims.
`Having thus described my invention, what I claim and
`desired to secure by Letters Patent, is:
`1. A cytologic instrument comprising a device having a
`holder which is provided with means for removing cells
`by abrasion from a part of a patient’s body, said holder
`having provision to guide said abrasive means during the
`insertion thereof into and the removal thereof from the
`patient’s body, and means for releasably securing said
`abrasive means to said holder, whereby to provide said
`instrument with a new abrasive means for each patient-
`use thereof, said securing means comprising a chuck pro-
`vided on said holder for releasably holding said brasive
`means in operative disposition thereof.
`2. An abrasive cytologic instrument comprising a de-
`vice having a holder provided with an abrasive brush for
`removing cells by abrasion from a part of a patient’s
`body, and said holder being substantially rigid for guid-
`ing the brush into and out of an opening in a patient’s
`body, and a chuck provided on said holder for releasably
`retaining said brush in operative disposition.
`3. A cytologic instrument comprising a device having
`a holder which is provided with means for removing cells
`by abrasion from a part of a patient’s body, said holder
`for said abrasive means, and a shield for said abrasive
`means, said holder being movable relative to said shield
`for moving said abrasive means into a shielded disposi-
`tion thereof to prevent contact of said abrasive means
`with the patient’s body during withdrawal of the instru-
`ment therefrom.
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`holder for " said abrasive means and a shield for said
`abrasive means, said holder being movable relative to
`said shield for moving said abrasive means into a shielded
`disposition thereof to prevent contact of said abrasive
`means with the patient’s body during withdrawal of the
`instrument therefrom, and adjustable detent means pro-
`vided on said shield for limiting the insertion of said
`instrument into the patient’s body.
`5. A cytologic instrument comprising means for re-
`moving cells by abrasion from a part of a patient’s body,
`and a holder for said abrasive means having provision to
`guide the latter during the insertion thereof into and the
`removal thereof from the patient’s body, and a member
`provided on said instrument for releasable inter-engage—
`ment with a body—grasping instrument, whereby to fa—
`cilitate the operation of said cytological instrument.
`6. A laryngeal abrasive cytologic instrument compris-
`ing a tubular holder member, a brush provided with a
`stern extending into said holder and having bristles dis-
`posed outwardly of one end of said holder member, said
`holder member being provided with an arcuate portion
`adjacent said one end to facilitate the entry of said instru-
`ment into a patient’s larynx for operatively disposing
`said brush in the larynx or trachea, and a handle pro-
`vided on said holder at the other end thereof, said handle
`having provision to secure said brush stem in said holder.
`7. A laryngeal abrasive cytologic instrument compris-
`ing a tubular holder member, a brush provided with a
`stem extending into said holder and having bristles dis-
`posed outwardly of one end of said holder member, said
`holder member being provided with an arcuate portion
`adjacent said one end to facilitate the entry of said instru-
`ment into a patient’s larynx for operatively disposing said
`brush in the larynx or trachea, and a handle provided
`on said holder at the other end thereof, and a chuck pro-
`vided in said handle for releasably securing said stem in
`said holder.
`
`8. A holder for a cytologic brush comprising an elon-
`gated tubular member adapted to receive a brush stem
`therein, a handle provided on said tubular member, and
`a releasable chuck provided in said handle for releasably
`securing the brush stern in said tubular member.
`9. A holder for a cytologic brush comprising an elon-
`gated tubuiar member adapted to receive a brush stern
`therein, a handle provided on said tubular member, and
`a chuck provided in said handle for releasably securing
`the brush stem in said tubular member, said member
`being curved to facilitate the entry thereof into a body
`Opening.
`‘
`10. An abrasive cytologic instrument comprising an
`elongated tubular member adapted to receive a brush
`stem therein, means on said member for releasably se-
`curing the brush stem thereto, and a tubular shield for
`entry into a patient’s body, said tubular member being
`mounted within said shield for relative movement, where-
`by the brush can be withdrawn into the shield after an
`abrading operation thereof on a body part to prevent
`contact between the brush and the patient’s body as the
`instrument is withdrawn therefrom.
`ll. An abrasive cytologic instrument comprising an
`elongated tubular member adapted to receive a brush stem
`therein, means on said member for releasably securing the
`brush stem thereto, and a tubular shield for-entry into
`a patient’s body, said tubular member being mounted
`within said shield for relative movement, whereby the
`brush can be withdrawu into the shield after an abrading
`operation thereof on a body part to prevent contact be-
`tween the brush and the patient’s body as the instrument
`is withdrawn therefrom, a handle provided on said tubu-
`lar member, and a chuck provided in said handle for
`releasably securing the brush stern in said tubular mem-
`ber.
`
`4. A cytologic instrument comprising a device having
`a holder which is provided with means for removing
`cells by abrasion from a part of a patient’s body, said
`
`75
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`12. An abrasive cytologic instrument comprising an
`elongaged tubular member adapted to receive a brush
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`2,839,049
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`'7
`stem therein,‘ means on said member for releasably se-'
`curingthe brush stem thereto, and a tubular shield for
`- entry intora patient’s'body said tubular member being
`mounted within said shield for relative movement, where-
`by the brush can be withdrawn into the shield after an
`abrading operation thereof on a body part to prevent
`contact between the brush and the patient’s body as the
`instrument is withdrawn therefrom, and a part provided
`on said shield for inter-engagement with a body-grasp—
`, ing instrument, wherebyto facilitate theoperation of
`said cytological instrument.
`»
`13. An abrasive cytologic instrument comprising an
`elongated tubular member adapted to receive a brush
`stern therein, means on said member for releasably se-
`curing the brush stem thereto, and a tubular shield for
`entry into a patient’s body, said tubular member being
`mounted within said shield for relative movement, Where-
`by the brush can be withdrawn into the shield after an
`abrading operation thereof on a body part to prevent con-
`tact between the bru'sh and the :patient’s body as the
`instrument is withdrawn therefrom, and adjustable de-
`
`8
`tent means provided on said shield for-limiting the in:
`sertion of said instrument into therpatient’ls body.
`14. An abrasive cytologic instrument comprising a
`brush provided with an elongated stem, an elongated tubu--
`lar brush holder intorwhich said stem extends, a part
`providedon said holder for releasably securing said stem,
`thereto, and a tubular shield within which saidvholderis
`mounted for relative movement, the bristles of said brush
`normally extending outwardly of said shield during an
`abrading operation of said instrument within the patient’s
`body, and said holder being operable to withdraw said
`bristlesrinto said shield to prevent contact of saidbristles
`and the patient’s body during removal of the instrument.
`References Cited in the file of this patent
`UNITED STATES PATENTS
`
`1,711,352,
`1,776,443
`
`Jeifreys ________________ Apr. 30, 1929
`Martin ____._...___' ______L Sept. 23,1930
`OTHER REFERENCES
`
`“Cancer,” ,vol. No. 6, November 1953, pp. ,1 177—1179.
`
`10
`
`20
`
`6
`
`