Relation between sampling device and detection of abnormality in cervical smears: a meta-analysis of randomised and quasi-randomised studies.
OBJECTIVE
To assess the diagnostic yield of different sampling devices used in cervical screening.


METHODS
Meta-analysis of randomised and quasi-randomised studies.


METHODS
All randomised and quasi-randomised studies comparing the yield of cytological or histological abnormalities when two or more different sampling devices were used.


METHODS
85,000 patients included in 29 studies reported in 28 papers.


METHODS
Pooled relative risk and 95% confidence interval of the yield of mild dysplasia or worse in smears recovered by each sampling method versus each other method with which it was compared; sensitivity or positive predictive value, or both, of cytological versus histological results in six studies from which sufficient data were available.


RESULTS
There were no substantial differences in the yield of cytological abnormalities between the Ayre spatula, the Cytobrush, and the cotton swab used alone. There were also no substantial differences in the yield of cytological abnormalities between the extended tip spatula, the Ayre spatula combined with the Cytobrush or cotton swab, or the Cervex brush. The Ayre spatula, Cytobruah, or cotton swab used alone generally performed significantly worse than the combinations, the extended tip spatula, or the Cervex brush. There were no substantial differences in sensitivity or positive predictive value between the sampling methods.


CONCLUSIONS
These results support the use of either the extended tip spatula, a combination of any spatula plus the Cytobrush or cotton swab, or the Cervex brush for cervical screening.
Buntinx
F
F
Department of General Practice, Universities of Louvain, Belgium.
Brouwers
M
M
D005260:Female; D006801:Humans; D008403:Mass Screening / Q000295:instrumentation* / Q000592:standards; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000295:instrumentation* / Q000592:standards