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

BMJ 1996;313:721-723 (21 September)

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

Paola Dey, lecturer in public health,^a Stuart Collins, statistician,^a Minaxi Desai, consultant cytopathologist,^b Ciaran Woodman, professor of public health and cancer epidemiology ^a

^a Centre for Cancer Epidemiology, University of Manchester, Manchester M20 4QL, ^b Department of Cytopathology, Christie Hospital NHS Trust, Manchester M20 4QL

Correspondence to: Dr Paola Dey, Centre for Cancer Epidemiology, Christie Hospital NHS Trust, Manchester M20 4QL.

Abstract

Objective: To compare the adequacy of cervical cytology samplingwith two sampling instruments commonly used in primary care--namely,the Aylesbury spatula and the Cervex brush.
Design: Pair matched, population based randomised controlledtrial.
Setting: 86 general practices and family planning clinics inGreater Manchester.
Subjects: 15 882 cervical smears taken from women aged 20-64years as part of the national cervical screening programme.
Interventions: Participating centres were allocated to samplewith 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 takenwith the Cervex brush and the Aylesbury spatula respectivelywere reported as inadequate (odds ratio 0.95; 95% confidenceinterval 0.74 to 1.22).
Conclusion: The Cervex brush offers no advantage over the Aylesburyspatula in reducing inadequate smear rates in the primary caresetting.

Key messages

Cervical sampling instruments have rarely been formally evaluated in population based settings
Group randomisation is useful when evaluating community based interventions but requires modified statistical techniques
The Cervex brush offers no advantage over the Aylesbury spatula in reducing rates of inadequate smears when used in primary care

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