Martin-Hirsch P, Jarvis G, Kitchener H, Lilford R
University Department of Obstetrics and Gynaecology, St Mary's Hospital, Whitworth Park, Manchester, UK, M13 0JH.
Cochrane Database Syst Rev. 2000(3):CD001036. doi: 10.1002/14651858.CD001036.
Few randomised controlled trials have sufficient power to show clear advantages of different designs of cervical smear collection devices. We studies whether the design of the cervical smear collection device affects rates of inadequate smears and detection of disease and whether the presence of endocervical cells in the smear affects detection of disease.
The false-negative rate of cervical smears varies between 1.5% and 55%. This variation may be partly due to differences in sampling device and technique. The objective of this review was to assess different cervical sampling devices for collecting endocervical cells, which are thought to be a surrogate for detection of abnormal cells and adequate smear rates.
We searched the Cochrane Gynaecological Cancer Group trials register and MEDLINE up to July 1997. We also handsearched 16 journals.
Randomised and quasi-randomised trials and non-randomised comparative studies comparing cervical smear collection devices in women attending for primary screening, colposcopy following an abnormal smear or colposcopy after treatment.
Two reviewers independently abstracted data. Study quality was assessed.
Thirty-four trials and six observational comparative studies were included. The Ayre spatula was shown to be less effective compared with extended tip spatulas for collecting endocervical cells in eight trials (odds ratio 2.25, 95% confidence interval 2.06 to 2.44). Use of a spatula with the cytobrush was more effective than spatula alone at collecting endocervical cells (odds ratio 3.33, 95% 3.05 to 3.63) and the same effect was present for adequate smear rates (odds ratio 1.51 95% 1.19-1.92). Extended tip spatulas were also superior for the detection of dyskaryosis in seven trials (odds ratio 1.21, 95% confidence interval 1.10 to 1.33). Based on data from two trials and three observational studies, smears that contained endocervical cells were more likely to detect dyskaryosis, particularly in severe disease. The proportion of smears with endocervical cells present increased with increasing severity of the disease.
REVIEWER'S CONCLUSIONS: Extended tip spatulas of various designs appear to be better for collecting endocervical cells than the commonly used Ayre spatula. The most effective combination appears to be the cytobrush with an extended tip spatula. The rate of detection of endocervical cells appears to be a valid and convenient surrogate for the ability to detect dyskaryosis and for adequate smear rates. The ability of the extended tip spatula with the cytobrush compared with the extended tip spatula alone to detect disease, needs to be evaluated in a trial.
很少有随机对照试验有足够的效力来表明不同设计的宫颈涂片采集装置具有明显优势。我们研究了宫颈涂片采集装置的设计是否会影响涂片不合格率和疾病检测率，以及涂片中宫颈管细胞的存在是否会影响疾病检测。
宫颈涂片的假阴性率在1.5%至55%之间。这种差异可能部分归因于采样装置和技术的不同。本综述的目的是评估不同的宫颈采样装置，用于采集宫颈管细胞，宫颈管细胞被认为是检测异常细胞和足够涂片率的替代指标。
我们检索了Cochrane妇科癌症组试验注册库以及截至1997年7月的MEDLINE。我们还手工检索了16种期刊。
比较参加初次筛查、涂片异常后行阴道镜检查或治疗后行阴道镜检查的女性的宫颈涂片采集装置的随机和半随机试验以及非随机对照研究。
两名评价员独立提取数据。评估研究质量。
纳入了34项试验和6项观察性比较研究。在8项试验中，与延长头刮板相比，艾yre刮板在采集宫颈管细胞方面效果较差（优势比2.25，95%置信区间2.06至2.44）。使用刮板结合细胞刷在采集宫颈管细胞方面比单独使用刮板更有效（优势比3.33，95% 3.05至3.63），在足够涂片率方面也有相同效果（优势比1.51，95% 1.19 - 1.92）。在7项试验中，延长头刮板在检测核异质方面也更具优势（优势比1.21，95%置信区间1.10至1.33）。基于两项试验和三项观察性研究的数据，含有宫颈管细胞的涂片更有可能检测到核异质，尤其是在严重疾病中。存在宫颈管细胞的涂片比例随着疾病严重程度的增加而增加。
各种设计的延长头刮板在采集宫颈管细胞方面似乎比常用的艾yre刮板更好。最有效的组合似乎是细胞刷与延长头刮板。宫颈管细胞的检测率似乎是检测核异质能力和足够涂片率的有效且方便的替代指标。与单独使用延长头刮板相比，细胞刷与延长头刮板组合检测疾病的能力需要在一项试验中进行评估。
