The Inadequacies of Instruments Used for Cervical Screening

Spurred, B.; Ayer, B; Pacey, N.F.

doi:10.1111/j.1479-828x.1989.tb02875.x

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…This correlation was shown earlier by Spurret et al 2 In our study a positive relationship between the absence of squamous cells in the Cytobrush sample and the probability of a false negative assessment was suggested as well.…”

supporting

confidence: 89%

Composition of cervical smears in patients with and without a cervical ectropion.

Buntinx

Essed²,

Putten³

et al. 1995

Journal of Clinical Pathology

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Aims-To test the hypothesis that absence of squamous cells in cervical smears obtained by an endocervical sampling technique is more prominent in patients with a cervical ectropion. Methods-Prospective study exploring the relation between the composition of cervical smears obtained using an endocervical cotton swab in patients with (n = 188) and without (n = 341) a cervical ectropion. Subjects were 529 consecutive patients from whom a cervical smear was prepared at a university gynaecological clinic. Results-In 7% of the endocervical samples no squamous cells were found. There was no correlation, however, between the presence or the size of an ectropion and the absence of squamous cells in those samples. Conclusions-It was confirmed that endocervical sampling alone is insufficient to obtain good quality cervical smears. The presence of an ectropion proved to be an unreliable predictor of the absence of squamous cells. (J Clin Pathol 1995;48:408-409) Keywords: Cervical screening, quality assurance. Department of MethodsThe study is based on 529 consecutive cervical smears prepared by three staff members of the gynaecological clinic of the University hospital of Maastricht, The Netherlands. For each patient a paired sample, using firstly a cotton swab and secondly an extended tip spatula, was produced. The age of the patient and the occurrence and degree of any cervical ectropion were registered during consultation. The presence of squamous and endocervical cells, respectively, was recorded for each sample by the university's cytology department.The screening personnel in the cytology department were not aware of the aim of the study.For each sampling method the relationship between the presence and the size of any ectropion and the presence of squamous and endocervical cells was examined. For statistical analysis the x' test and Fisher's exact test for independent proportions were used. The x2 test for trend was used in analysing the relationship between the size of the cervical ectropion and the presence of the studied cell types. The McNemar test for paired samples was used to examine the significance of the relationship between the presence in the smear of both cell types and the sampling method employed.A sample size computation was made before the start of the study, and updated whenever new data became available. Accepting a possible type I error of 5% and a type II error of 10%, 531 smears would be sufficient to detect a difference of at least 10% in the number of samples lacking squamous cells between the groups with or without a cervical ectropion. ResultsThere was a strong relationship between the sampling method (spatula or cotton swab) and the presence of both endocervical and squamous cells, the spatula performing better for both cell types (p<0_001; X2). SQUAMOUS CELLSSquamous cells were lacking in 36/529 (7%) of the cotton swab samples. In the presence of an ectropion these cells were absent in 4% of all cotton swab samples. Without an ectropion, they were absent in 8%. The difference w...

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supporting

confidence: 89%

Composition of cervical smears in patients with and without a cervical ectropion.

Buntinx

Essed²,

Putten³

et al. 1995

Journal of Clinical Pathology

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“…Of 41 papers retrieved, 13 were excluded because of lacking essential crude data,14 15 the use of a cohort16 17 or pre-post5 6 15 18 19 20 21 design, extreme selection of patients,22 inadequate definition of method23 or outcome,24 or reporting partial results from a study on which a later report was available 5. One report described two different studies, which we considered separately 10.…”

Section: Resultsmentioning

confidence: 99%

Relation between sampling device and detection of abnormality in cervical smears: a meta-analysis of randomised and quasi-randomised studies

Buntinx

Brouwers

1996

BMJ

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“…For the Cervex Brush, only (20) 8.4% of cells were transferred to the slide . Regarding the morphology of cells, no criticisms were made of slides prepared from the LonStenn (23). Literature reports suggest that there may be cytological changes in smears made from cells harvested utilizing the Cytobrush, requiring analysis by an experienced cytologist (23).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the morphology of cells, no criticisms were made of slides prepared from the LonStenn (23). Literature reports suggest that there may be cytological changes in smears made from cells harvested utilizing the Cytobrush, requiring analysis by an experienced cytologist (23). Some initial comments made by the cytologist when the LonStenn device was used indicated thick areas, relating to excess material, making reporting difficult.…”

Section: Discussionmentioning

confidence: 99%

“…No endometrial cells were found in cellular samples obtained from the LonStenn. However the presence of such cells may occur when the Cytobrush is used and may lead to the incorrect diagnosis of abnormal cells (23). The single unit LonStenn is easier to plateout and thus has very few preservation inadequacies and air drying artefacts, which are seen more commonly with the combined Cytobrush and Spatula method because of its two-step method (23~.…”

Section: Discussionmentioning

confidence: 99%

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The LonStenn—a new cervical sampling device

Stenning¹,

Stenning

Rajasekariah³

et al. 1995

Int J Gynecol Cancer

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A new cervical sampling device, the 'LonStenn' was evaluated against devices in common use: the Cervex Brush, and the CytoBrush plus Ayres Spatula, by comparing the number of cells removed from the cervix and the number released from the device onto a glass slide. One hundred and eighty patients were studied. Ninety patients had Papanicolaou (Pap) smears, and at the same examination, colposcopy and biopsies, with 30 patients being allocated to each of the three sampling methods. After the plating of the Pap smear, the 'head' of the device was cut off and placed in a vial of Tyrode saline solution and vortexed. The residual cells remaining in the saline solution were counted in a Kova Slide Chamber. This allowed assessment of one possible cause of false negatives (ie, cell entrapment). A control group of 90 patients, with 30 allocated to each device, had Pap smears taken which were not plated out: the head of the device was removed and again placed in Tyrode saline solution. The cells harvested from the cervix were counted by the same method as before. The subtraction of the cells from the plated-out group from the control (nonplated out) group gave an indication of the number of cells delivered to the slide for cytological evaluation. The LonStenn is shown to be more efficient in its quantitative delivery of representative harvested cells from the cervix to a glass slide for cytological analysis. Qualitative assessment of smears prepared from this device suggested an improvement, as indicated by less blood staining. This should also ultimately be reflected by a decrease in false negatives in the laboratory.

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The Inadequacies of Instruments Used for Cervical Screening

Cited by 6 publications

References 7 publications

Composition of cervical smears in patients with and without a cervical ectropion.

Composition of cervical smears in patients with and without a cervical ectropion.

Relation between sampling device and detection of abnormality in cervical smears: a meta-analysis of randomised and quasi-randomised studies

The LonStenn—a new cervical sampling device

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