Objective

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

Data Sources

Four bibliographic databases were searched on June 9, 2022, with no date or language restrictions.

Study Eligibility Criteria

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

Methods

The review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021222406). Two authors independently screened studies, extracted data, performed the risk-of-bias assessment (Quality Assessment of Diagnostic Accuracy Studies-2), and rated the certainty of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. A meta-analysis of diagnostic test accuracy was performed using a bivariate random-effects model.

Results

We included 7 studies: 4 diagnostic cohort studies and 3 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% confidence interval, 48–95; 799 women; 7 studies; low quality of evidence) for endocervical brush and 70% (95% confidence interval, 42–89; 761 women; 7 studies; low quality of evidence) for endocervical curettage. Overall pooled specificity was 73% (95% confidence interval, 36–93; 799 women; 7 studies; low quality of evidence) for endocervical brush and 81% (95% confidence interval, 56–94; 761 women; 7 studies; low quality of evidence) for endocervical curettage. The risk ratio for inadequate samples with endocervical curettage compared with endocervical brush was 2.53 (95% confidence interval, 0.58–11.0; P=.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 in diagnostic accuracy, inadequate sampling rate, and adverse effects based on low-quality of evidence. Variation in the characteristics of women and the resulting diagnostic pathways make the external validity limited.

中文翻译：

---

疑似宫颈瘤变女性的宫颈管取样：诊断测试准确性研究的系统回顾和荟萃分析

客观的

疑似宫颈瘤形成的女性的宫颈管取样可通过宫颈管刷或宫颈管刮除术进行。本研究旨在评估两种测试的诊断准确性、不适感和样本不足的数量。

数据源

2022 年 6 月 9 日检索了四个书目数据库，没有日期或语言限制。

学习资格标准

我们纳入了所有诊断研究和随机临床试验，这些试验在有阴道镜检查指征的女性中比较了宫颈管刷与宫颈管刮除术。

方法

审查协议已在国际前瞻性系统审查登记册 (PROSPERO) (CRD42021222406) 上注册。两位作者独立筛选研究、提取数据、进行偏倚风险评估（诊断准确性研究的质量评估-2），并使用推荐、评估、开发和评估分级 (GRADE) 对证据的确定性进行评级方法。使用双变量随机效应模型对诊断测试准确性进行荟萃分析。

结果

我们纳入了 7 项研究：4 项诊断队列研究和 3 项随机临床试验。参考标准是锥切术或子宫切除术。一些关于患者选择、流程和时间安排的研究存在偏倚风险和对适用性的担忧。宫颈内刷的总体汇总敏感性为 81%（95% 置信区间，48-95；799 名女性；7 项研究；低质量证据）和 70%（95% 置信区间，42-89；761 名女性；7 项研究；低质量证据）证据质量）用于宫颈管刮除术。宫颈内刷的总体合并特异性为 73%（95% 置信区间，36-93；799 名女性；7 项研究；低质量证据）和 81%（95% 置信区间，56-94；761 名女性；7 项研究；低质量证据）证据质量）用于宫颈管刮除术。P =.215；低质量证据）。两项研究报告了患者的不适；一个发现宫颈内膜刷组的不适较少，另一个发现没有差异。

结论

基于低质量证据，宫颈内刷和宫颈内刮除术在诊断准确性、采样率不足和不良反应方面没有差异。女性特征的差异以及由此产生的诊断途径使得外部有效性受到限制。