Authors' recommendations: Research base and potential for further reviewFollowing an extensive, systematic search of published research and consideration of various website sources, it appears that there is a very small literature on the topic of the effectiveness of the design of collection devices for cervical screening that adds to the Cochrane Collaboration review published in 2000. This update has identified two recent prospective cohort studies assessing the performance of cervical smear collection devices following the publication of the comprehensive Cochrane review by Martin-Hirsch et al. (2000). From what has been identified in this brief report, there does not appear to be sufficient evidence of reasonable quality on this topic to benefit from more extensive review and critical appraisal as an evidence-based review (either as a HSAC Technical Brief or Systematic Review).The Cochrane review conclusions we believe are still applicable, as confirmed by the review’s author in email correspondence (Martin-Hirsch, personal communication, 2008). Hence, we believe there is no new substantial evidence published since this Cochrane review that might influence the conclusions of the review. The Cochrane review authors indicated in the section on implications for practice that the review is no longer appropriate for update as liquid based cytology has superseded smear technology (Martin-Hirsch et al. 2000). The most important factor in taking satisfactory cervical smears is the ability of the practitioner to perform the test accurately (Cecchini 1989; Buntinx 1993). As shown by this review, the design of the cervical smear collection device also significantly influences the yield of representative cells and the detection of cytological atypia. The replacement of the Ayre spatula with extended tip spatulas should be mandatory for mass screening since this is an inexpensive way to improve sampling. In the United Kingdom the presence of endocervical cells is not routinely used to assess the adequacy of a cervical smear. The evidence from the observational studies suggests that endocervical negative smears are less likely to detect any cytological abnormality which may be present, especially if theabnormality is severe. The introduction of more stringent assessment of cervical smears based on endocervical cell status and the repetition of endocervical negative smears might not be justified in the light of the present resources. However, assessment of endocervical cells appears to be a valid method to audit an aspect of the overall quality of a cervical smear screening program and to compare different cervical sampling collection devices (Martin-Hirsch et al. 2000).

Project Status: Completed

URL for project: http://www.healthsac.net/downloads/publications/HSAS08%20Cervical%20Collection%20Devices%20170908%20FINAL.pdf

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: Health Services Assessment Collaboration

Contact Address: University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand

Contact Name: hsac@canterbury.ac.nz

Contact Email: hsac@canterbury.ac.nz

Copyright: Health Services Assessment Collaboration (HSAC)