User perception of endocervical sampling: A randomized comparison of endocervical evaluation with the curette vs cytobrush

<div><p>Objectives</p><p>To evaluate whether the endocervical brush (ECB) is better accepted by patients and health care providers for endocervical evaluation when compared to the endocervical curette (ECC), without a decrease in the quality of sampling.</p><p>Methods</p><p>Two hundred patients with cervical dysplasia were randomized at the colposcopy clinic of the University Hospital of Geneva into two groups according to technique. Patients and physicians’ preference regarding the technique as well as the quality of samples were assessed. ECB samples were analyzed using both cytological (cell block) and histologic analysis, while ECC samples were analyzed using standard histologic analysis.</p><p>Results</p><p>Of the 200 patients, 89 were randomized to ECC, 101 to ECB and 10 were excluded due to incomplete information or cervical stenosis. Physicians preferred ECB against ECC, classifying it more frequently as an easy technique (94.1% vs.61.4%, p<0.001). Physicians more frequently evaluated the ECB as little or not uncomfortable for patients (28.7% vs.10.2%, p<0.001), though patients themselves didn’t express a preference for either technique. From a quality standpoint, the brush allowed for a better quality of samples, with a lower rate of inadequate samples (2.0% vs 14.3%, p = 0.002) and greater amount of material.</p><p>Conclusion</p><p>Endocervical sampling using ECB seems to be easier to perform and provides better quality samples. ECB can therefore be an acceptable alternative to ECC in standard practice.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01435590" target="_blank">NCT01435590</a></p></div

Flowchart of study participants.

<p>ECB: endocervical brushing, ECC: endocervical curette.</p

Patient's acceptability of the procedure by study group.

<p>Patient's acceptability of the procedure by study group.</p

Specimen adequacy by study group.

<p>Specimen adequacy by study group.</p

Patient characteristics by study group.

<p>Patient characteristics by study group.</p

Doctors' perception and evaluation of each procedure (n = 190).

<p>Doctors' perception and evaluation of each procedure (n = 190).</p

Cytokine and chemokine responses to BCG infection.

<p>TNF-α (A), IL-17 (B), IL-12p40 (C), IFN-γ (D), CXCL1 (E) and CCL5 (F) were assessed in lung homogenates obtained 3 days and 4 weeks after BCG infection. Results are presented as the mean ± SEM (n = 4–7 mice per group). (**: p<0.05, *: p<0.01).</p

Analysis of published cases of mycobacterial infections in CGD patients.

<p>Our literature research identified a total of 297 published cases of mycobacterial disease in CGD patients. (A) Mycobacterial species recovered in mycobacterial disease in CGD patients. (B) Clinical presentations of <i>Mycobacterium bovis</i> BCG and <i>Mycobacterium tuberculosis</i> infections in CGD patients. The numbers indicated on top of each column represent the percentage with respect to the total number of BCG or <i>M. tuberculosis</i> cases, respectively. The terms “systemic” refers to disseminated or to lung infections.</p

Impact of CGD mutation on mortality and weight loss in response to BCG infection.

<p><i>Ncf1</i> mutant (loss of function mutation in p47^phox), <i>Ncf1</i> rescue (expression of wild-type p47^phox in mononuclear phagocytes) with C57Bl/10.Q background, <i>Ncf1</i> mutant (loss of function mutation in p47^phox) with C57Bl/6 background, <i>Cybb</i><b>-</b>deficient and their respective wild-type controls were injected intravenously with BCG (10⁷ CFU). Survival was monitored over the 4 weeks period following BCG inoculation in (A) C57Bl/10.Q wild-type (n = 15), <i>Ncf1</i> mutant (n = 15) and <i>Ncf1</i> rescue (n = 11), in (C) C57Bl/6 wild-type (n = 7), <i>Ncf1</i> mutant (n = 6) and (E) C57Bl/6 wild-type (n = 7), <i>Cybb</i><b>-</b>deficient (n = 9) mice. (B, D and F) Body weight changes as a function of time after BCG inoculation. Survival (percent of initial number of mice) is shown in brackets. Statistics shown in the figures are the comparison between respective wild-type and <i>Ncf1</i> mutant or <i>Cybb</i><b>-</b>deficient (***: p<0.001, **: p<0.05, *: p<0.01) and the comparison between <i>Ncf1</i> mutant and rescue (§§§: p<0.001 and §§: p<0.01). Note that no significant differences were observed between wild-type and <i>Ncf1</i> rescue mice.</p

Lung parameters in response to BCG infection.

<p>(A) Lung/weight ratio of wild-type (n = 9), <i>Ncf1</i> mutant (n = 5) and <i>Ncf1</i> rescue (n = 8) mice without BCG infection and at 3 days and 4 weeks post infection. (B) Determination of alveolar space score (occupied lung tissue <i>vs.</i> free space) in lung sections at 4 weeks post infection. Data are represented as the mean of alveolar space score ± SD in 4 mice per group with at least 3 lobes analyzed per mouse. (C) Number of viable bacteria was determined at 3 days and 4 weeks following BCG infection. Data are shown as mean log of CFU per organ (±SEM; 3–5 mice per group). (D) iNOS protein expression in lung was detected by western blot 4 weeks after BCG infection. Results are expressed as mean ± SEM of relative units of iNOS/actin (n = 4, per group) after quantification by Image Quant software. (E) Nitrotyrosine quantification by ELISA was done in lungs, 4 weeks after BCG infection. Results are expressed as mean ± SEM of nM per lung (n = 4–5, per group). (***: p<0.001, **: p<0.05, *: p<0.01).</p