Cervical sampling devices

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7068.1275 (Published 23 November 1996) Cite this as: BMJ 1996;313:1275
  1. Peter Sasieni
  1. Research scientist Department of Mathematics, Statistics and Epidemiology, Imperial Cancer Research Fund, London WC2A 3PX

    Extended tip spatulas (such as the Aylesbury) should replace the Ayre

    In 1994–5, 4.5 million cervical smears were examined in England; over 350 000 (7.9%) were deemed inadequate.1 Inadequacy rates reported by the 183 laboratories ranged from 0.2-35.5%. Such variation is unacceptable and must in part reflect different reporting criteria. Guidelines that should lead to a greater uniformity in reporting have since been circulated.2 The rates also depend, however, on the quality of smear taking, and there is room for improvement here too.

    In this week's BMJ, Buntinx and Brouwers (p 1285) review the relation between sampling devices and detection of dyskaryosis.3 The data suggest that extended tip spatulas (such as the Aylesbury) should be used in preference to Ayre spatulas and that brushes may be beneficial when used in conjunction with spatulas but that they should not be used alone. Here I will consider the appropriateness of combining results from studies with very different designs and the appropriateness of the endpoints used to evaluate screening.

    The ideal sampling device would maximise the amount of cervical cancer …

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