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

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisReviewForskningpeer review

DOI

  • Mathias Damkjær, Amager and Hvidovre Hospital, University Hospital of Copenhagen, Hvidovre
  • ,
  • Jacob Brink Laursen, University Hospital Rigshospitalet, Copenhagen, Denmark.
  • ,
  • Lone Kjeld Petersen
  • Doris Schledermann, Department of Pathology, Odense University Hospital, Odense
  • ,
  • Berit Bargum Booth
  • ,
  • Britta Blume Dolleris, Department of Gynecology and Obstetics, Odense University Hospital.
  • ,
  • Henrik Sehested Laursen
  • Jeppe Schroll, Amager and Hvidovre Hospital, University Hospital of Copenhagen, Hvidovre, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

OBJECTIVE: Endocervical sampling in women with suspected cervical neoplasia can be obtained by either endocervical brush or endocervical curettage. We aimed to estimate the diagnostic accuracy, discomfort and number of inadequate samples with either test.

DATA SOURCES: Four bibliographic databases were searched on the 9th of June 2022, with no date or language restrictions.

STUDY ELIGIBILITY CRITERIA: We included all diagnostic studies and randomized clinical trials that compared the endocervical brush to endocervical curettage in women with an indication for colposcopy.

STUDY APPRAISAL AND SYNTHESIS METHODS: The review protocol was registered at PROSPERO (CRD42021222406). Two authors independently screened studies, extracted data, carried out the risk of bias assessment (QUADAS-2) and rated the certainty of the evidence using GRADE. A meta-analysis of diagnostic test accuracy was performed using a bivariate random-effects model.

RESULTS: We included seven studies. Four diagnostic cohort studies and three randomized clinical trials. The reference-standard was conization or hysterectomy. Risk of bias and concern about applicability were high for some of the studies in patient selection and flow and timing. Overall pooled sensitivity was 81% (95% CI 48% to 95%, 799 women, 7 studies, low quality of evidence) for endocervical brush and 70% (95% CI 42% to 89%, 761 women, 7 studies, low quality of evidence) for endocervical curettage. Overall pooled specificity was 73% (95% CI 36% to 93%, 799 women, 7 studies, low quality of evidence) for endocervical brush and 81% (95% CI 56% to 94%, 761 women, 7 studies, low quality of evidence) for endocervical curettage. The risk-ratio for an inadequate sample for endocervical curettage compared to endocervical brush was risk-ratio = 2.53 (95% CI 0.58 to 11.0, p-value = 0.215) (low certainty evidence). Two studies reported on patient discomfort; one found less discomfort in the endocervical brush group and the other found no difference.

CONCLUSION: No difference was found between endocervical brush and endocervical curettage for diagnostic accuracy, inadequate sampling rate and adverse effects based on low quality evidence. Variation in the characteristics of women and the resulting diagnostic pathway makes the external validity limited.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Obstetrics and Gynecology
ISSN0002-9378
DOI
StatusE-pub ahead of print - 4 aug. 2022

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Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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