A comparison of four cytological sampling techniques in a genitourinary medicine clinic

An audit of Colposcopy referrals from a GU/STD clinic

BACKGROUND

Cervical cancer is increasing at 1.5% per year in Ireland with 50% mortality giving 2.2% of all cancer deaths. In the Mid-West region a pilot screening programme has begun to screen all women 25-60 years. 66% of Genitourinary/Sexually transmitted disease (GU/STD) clinics' abnormal smears are <25 years. Requests to abandon "opportunistic" screening prompted this GU/STD clinic audit.

METHODS

221(8.4%) patients referred to colposcopy over 4 years were audited. Retrospective analysis was carried out on GU/STD clinic files, hospital files and computer records for biopsy reports. Ethical approval was prospectively granted.

RESULTS

2637 smears were carried out from November 1999 - September 2003.221 patients referred to colposcopy were audited.1%, 3%, 5% had severe, moderate and, mild dyskaryosis, respectively, on cervical screening while 0.8%, 1.2%, 1.5% had CIN3, CIN2, CIN1 abnormalities, respectively, on biopsy with 3.5% having no abnormality (Cervical Intraepithelial Neoplasia = CIN).53% referred to colposcopy were <25 years.

CONCLUSION

2% had high grade lesions. 37% of high grade lesions are <25 years.Of the high grade lesions 13% had Chlamydia trachomatis (27% of CIN3) and 44% had HPV despite Relative Risks (RR) being 0.75 and 1.09 respectively. Older women had higher grade changes. No statistical difference was found for progression, regression and persistence in those over and under 25.

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.

DESIGN

Meta-analysis of randomised and quasi-randomised studies.

SETTING

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

SUBJECTS

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

MAIN OUTCOME MEASURES

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.

Adequacy of cervical cytology sampling with the Cervex brush and the Aylesbury spatula: a population based randomised controlled trial

OBJECTIVE

To compare the adequacy of cervical cytology sampling with two sampling instruments commonly used in primary care-namely, the Aylesbury spatula and the Cervex brush.

DESIGN

Pair matched, population based randomised controlled trial.

SETTING

86 general practices and family planning clinics in Greater Manchester.

SUBJECTS

15 882 cervical smears taken from women aged 20-64 years as part of the national cervical screening programme.

INTERVENTIONS

Participating centres were allocated to sample with either the Cervex brush or the Aylesbury spatula.

MAIN OUTCOME MEASURE

Inadequate smear rate.

RESULTS

5.4% and 5.5% (433/8086 and 426/7796) of smears taken with the Cervex brush and the Aylesbury spatula respectively were reported as inadequate (odds ratio 0.95; 95% confidence interval 0.74 to 1.22).

CONCLUSION

The Cervex brush offers no advantage over the Aylesbury spatula in reducing inadequate smear rates in the primary care setting.

Cytological reporting of cervical abnormalities according to endocervical status

An analysis of cytology reporting within Victorian Cytology Service demonstrates that the proportion of Papanicolaou smears which were reported as including an endocervical component increased from approximately one half during 1987-89 to more than three quarters during 1990-91. The improvement coincided with the routine provision of special sampling instruments to all practitioners supplemented by an education program. Despite the increase in endocervical sampling, no increase in the rate of reporting of high-grade intraepithelial lesions of the cervix has occurred. An increase between the two time periods in the cytological reporting of adenocarcinoma, adenocarcinoma in situ and endocervical dyskaryosis has occurred, but does not reach statistical significance.