Self-Sampling Versus Physicians' Sampling for Cervical Cancer Screening - Agreement of Cytological Diagnoses

  • Othman, Nor Hayati (Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Zaki, Fatma Hariati Mohamad (Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Hussain, Nik Hazlina Nik (Department of Obstetrics and Gynaecology, School of Medical Sciences, Universiti Sains Malaysia) ;
  • Yusoff, Wan Zahanim Wan (Department of Obstetrics and Gynaecology, Hospital Raja Perempuan Zainab II) ;
  • Ismail, Pazuddin (Department of Obstetrics and Gynaecology, School of Medical Sciences, Universiti Sains Malaysia)
  • Published : 2016.07.01


Background: A major problem with cervical cancer screening in countries which have no organized national screening program for cervical cancer is sub-optimal participation. Implementation of self-sampling method may increase the coverage. Objective: We determined the agreement of cytological diagnoses made on samples collected by women themselves (self-sampling) versus samples collected by physicians (Physician sampling). Materials and Methods: We invited women volunteers to undergo two procedures; cervical self-sampling using the Evalyn brush and physician sampling using a Cervex brush. The women were shown a video presentation on how to take their own cervical samples before the procedure. The samples taken by physicians were taken as per routine testing (Gold Standard). All samples were subjected to Thin Prep monolayer smears. The diagnoses made were according to the Bethesda classification. The results from these two sampling methods were analysed and compared. Results: A total of 367 women were recruited into the study, ranging from 22 to 65 years age. There was a significant good agreement of the cytological diagnoses made on the samples from the two sampling methods with the Kappa value of 0.568 (p=0.040). Using the cytological smears taken by physicians as the gold standard, the sensitivity of self-sampling was 71.9% (95% CI:70.9-72.8), the specificity was 86.6% (95% CI:85.7-87.5), the positive predictive value was 74.2% (95% CI:73.3-75.1) and the negative predictive value was 85.1% (95% CI: 84.2-86.0). Self-sampling smears (22.9%) allowed detection of micro-organisms better than physicians samples (18.5%). Conclusions: This study shows that samples taken by women themselves (self-sampling) and physicians have good diagnostic agreement. Self-sampling could be the method of choice in countries in which the coverage of women attending clinics for screening for cervical cancer is poor.


Supported by : USM RUI


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