User perception of endocervical sampling: A randomized comparison of endocervical evaluation with the curette vs cytobrush

Abstract

ObjectivesTo evaluate whether the endocervical brush (ECB) is better accepted by patients and health care providers for endocervical evaluation when compared to the endocervical curette (ECC), without a decrease in the quality of sampling.MethodsTwo hundred patients with cervical dysplasia were randomized at the colposcopy clinic of the University Hospital of Geneva into two groups according to technique. Patients and physicians’ preference regarding the technique as well as the quality of samples were assessed. ECB samples were analyzed using both cytological (cell block) and histologic analysis, while ECC samples were analyzed using standard histologic analysis.ResultsOf the 200 patients, 89 were randomized to ECC, 101 to ECB and 10 were excluded due to incomplete information or cervical stenosis. Physicians preferred ECB against ECC, classifying it more frequently as an easy technique (94.1% vs.61.4%, p<0.001). Physicians more frequently evaluated the ECB as little or not uncomfortable for patients (28.7% vs.10.2%, p<0.001), though patients themselves didn’t express a preference for either technique. From a quality standpoint, the brush allowed for a better quality of samples, with a lower rate of inadequate samples (2.0% vs 14.3%, p = 0.002) and greater amount of material.ConclusionEndocervical sampling using ECB seems to be easier to perform and provides better quality samples. ECB can therefore be an acceptable alternative to ECC in standard practice.Trial registrationClinicalTrials.gov NCT01435590

Endocervical sampling in women with suspected cervical neoplasia: a systematic review and meta-analysis of diagnostic test accuracy studies

“…Our results are in accordance with the RCT by Undurraga et al, 34 which reported a higher risk of inadequate samples with ECC than with EB (14.3% vs 2.0%; P¼.002), and we also reported a higher, albeit nonsignificant, risk of inadequate samples using ECC. The finding of an inadequate sample rate of 14.3% in the study by Undurraga et al 34 may be considered high. A study by Gage et al 38 with >13,000 ECC samples only reported an inadequate sample rate of 4%.…”

“…One study did not find any difference, and the other found a small association with slightly higher VAS score for ECC, but VAS of 2.55 vs VAS of 1.99 is not considered clinically relevant. 33 Our results are in accordance with the RCT from Undurraga et al, 34 reporting no difference in women's preference for the 2 procedures.…”

“…A study also examined combining EB and ECC for endocervical sampling, 39 reporting no difference in the amount of material attained from using both sampling techniques. However, their finding was in direct contrast to the findings by the newer RCT by Undurraga et al 34 More high-quality studies are needed to further address this idea of combined sampling.…”

Agreement Between Endocervical Brush and Endocervical Curettage for the Diagnosis of Cervical Cancer

“…Cervical cancer is the third most commonly diagnosed gynecologic cancer (1). It originates from pre-invasive lesions or cervical dysplasias arising from squamous and glandular cells in the cervical region (2). About 79.6% of these cancers are squamous and 19.2% are adenocarcinoma (3).…”

“…About 79.6% of these cancers are squamous and 19.2% are adenocarcinoma (3). Most cervical cancers begin in the cells in the transformation zone, which may vary depending on the age and hormonal status of the patient (2). The Papanicolaou test (Pap smear) is a noninvasive procedure used in the screening of preinvasive lesions and cervical dysplasia (4).…”