TY - JOUR
T1 - Endocervical sampling in women with suspected cervical neoplasia
T2 - A systematic review and meta-analysis of diagnostic test accuracy studies
AU - Damkjær, Mathias
AU - Laursen, Jacob Brink
AU - Petersen, Lone Kjeld
AU - Schledermann, Doris
AU - Booth, Berit Bargum
AU - Dolleris, Britta Blume
AU - Laursen, Henrik Sehested
AU - Schroll, Jeppe
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - cervical cancer
KW - diagnostic studies
KW - diagnostic test accuracy meta-analysis
KW - endocervical brush
KW - endocervical curettage
KW - endocervical neoplasia
KW - endocervical sampling
UR - http://www.scopus.com/inward/record.url?scp=85136257489&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2022.07.036
DO - 10.1016/j.ajog.2022.07.036
M3 - Review
C2 - 35934116
SN - 0002-9378
VL - 227
SP - 839-848.e4
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 6
ER -