Final participants:
During the study period, 135 women who met the criteria were located. Ten declined to participate. In addition, five were excluded, as the practitioner didn't consider the sample necessary for clinical reasons. By the end of recruitment, 120 participants had completed all phases, with 61 being assigned to the specimens conveyed dry and 59 to the ones transferred in liquid medium (Fig. 2).
Socio-demographic characteristics of participants:
The median age of the participants was 46 years old, and 62.5% were born in Spain. The predominant level of education was secondary or high school (39.2% of women). As to employment, 47.5% were in a situation of subsidy, mostly due to the COVID-19 pandemic. Table 2 shows the values of these variables in more detail. A comparison is made between the group that was supplied with the dry specimens and the one that received the liquid-based ones. No statistically significant differences were found between the two groups related to socio-demographic traits.
Table 2
Socio-demographic characteristics of the participants.
Variables
|
Total
(n = 120)
|
Dry self-sample
(n = 61)
|
Liquid self-sample
(n = 59)
|
p
|
Age
Median (interquartile range)
|
46 (40–51)
|
46 (40–51)
|
46 (40–52)
|
0.6171
|
Nationality at birth n (%)
|
|
|
|
|
Spain
|
75 (62.5%)
|
35 (57.4%)
|
40 (67.8%)
|
0.4115
|
Central and South America
|
26 (21.7%)
|
17 (27.9%)
|
9 (15.3%)
|
European Union and United Kingdom
|
9 (7.5%)
|
4 (6.6%)
|
5 (8.5%)
|
Others
|
10 (8.3%)
|
5 (8.2%)
|
5 (8.5%)
|
Completed educational level n (%)
|
|
|
|
|
Primary school
|
36 (30.0%)
|
13 (21.3%)
|
23 (39.0%)
|
0.2120
|
Secondary school
|
47 (39.2%)
|
27 (44.3%)
|
20 (33.9%)
|
Higher education
|
35 (29.2%)
|
20 (32.8%)
|
15 (25.4%)
|
No formal schooling
|
2 (1.7%)
|
1 (1.6%)
|
1 (1.7%)
|
Occupation n (%)
|
|
|
|
|
Employed/self employed
|
47 (39.2%)
|
19 (31.1%)
|
28 (47.5%)
|
0.2742
|
Social welfare recipients/retired
|
57 (47.5%)
|
32 (52.5%)
|
25 (42.4%)
|
No own income
|
12 (10.0%)
|
7 (11.5%)
|
5 (8.5%)
|
Others
|
4 (3.3%)
|
3 (4.9%)
|
1 (1.7%)
|
Evaluation of the pre-analytical phase of cervical-vaginal samples:
Only four of the 120 participants (3.3%) did not submit the specimen in due conditions. These cases were evenly distributed between the two groups of devices provided. Two participants delivered partially sealed containers, another discarded the Mía by Xytotest® device after rinsing it in the liquid medium, and the last one handed us the same device dry. However, the aforementioned defects could be corrected before sending the samples to the Pathology Department, except for recovering the discarded device, and it could be verified a posteriori that there was a full coincidence between the samples performed by the woman and the professional.
Adequacy and results of HPV and cytological analyses:
The results of the samples taken both by the collaborating gynaecologists and by the patients are shown in Table 3.
Table 3
Adequacy and results of HPV and cytological analyses.
Variables
|
Conventional samples
|
Samples in liquid medium
|
Dry samples
|
Viba-Brush®
|
Mía by Xytotest
|
Iune
|
Viscose
|
HPV test results n (%)
|
n = 120
|
n = 59
|
n = 59
|
n = 61
|
n = 61
|
Negative
|
75 (62.5%)
|
33 (55.9%)
|
34 (57.6%)
|
35 (57.4%)
|
38 (62.3%)
|
Type 16 ± other types
|
11 (9.2%)
|
9 (15.3%)
|
8 (13.6%)
|
7 (11.5%)
|
6 (9.8%)
|
Type 18 ± other types
|
4 (3.3%)
|
2 (3.4%)
|
2 (3.4%)
|
3 (4.9%)
|
3 (4.9%)
|
Only other types
|
30 (25.0%)
|
15 (25.4%)
|
15 (25.4%)
|
16 (26.2%)
|
14 (23.0%)
|
Specimen adequacy n (%)
|
n = 120
|
n = 59
|
n = 59
|
|
|
Unsatisfactory
|
24 (20.0%)
|
1 (1.7%)
|
1 (1.7%)
|
|
|
Satisfactory
|
Without endocervical
component
|
29 (24.2%)
|
43 (72.9%)
|
45 (76.3%)
|
|
|
With endocervical component
|
67 (55.8%)
|
15 (25.4%)
|
13 (22.0%)
|
|
|
Cytological results n (%)
|
n = 96
|
n = 58
|
n = 58
|
|
|
Negative
|
57 (59.4%)
|
38 (65.5%)
|
41 (70.7%)
|
|
|
ASC-US and LSIL
|
32 (33.3%)
|
19 (32.8%)
|
14 (24.1%)
|
|
|
ASC-H. AIS and HSIL
|
7 (7.3%)
|
1 (1.7%)
|
3 (5.2%)
|
|
|
HPV: human papillomavirus. |
ASC-US: atypical squamous cells of undetermined significance.
LSIL: low-grade squamous intraepithelial lesion.
ASC-H: atypical squamous cells, cannot exclude a high-grade.
AIS: adenocarcinoma in situ.
HSIL: high-grade squamous intraepithelial lesion.
Twenty per cent of unsatisfactory Pap smears from the samples taken by the clinicians contrasts with the corresponding percentages for specimens collected with Viba-Brush® and Mía by Xytotest®, which are 1.7% for each (only one inadequate cytology per device). So, the 118 pairs of Pap smears from samples taken by the professional and the patient were compared. Then, 24 of 118 self-collected samples (20.7%) became unsatisfactory when taken conventionally, while the only two inadequate results for the self-collection group did not reverse to satisfactory after the gynaecologist's sampling. The p-value for the paired test was significant (p < 0.01).
Next, 92 pairs of samples obtained by participants and by the gynaecologist were scrutinized, the results of which were consistent in 40 cases (43.5%). Twenty-two self-samples had an endocervical component and 70 did not. It was found that 4 of the 22 samples with endocervical cells (18.2%) went on to not have them when they arrived at the gynecologist's office, while 48 of the 70 samples without endocervical cells (68.5%) went on to have them when obtained by the gynecologist, the contrast being significant (p < 0.0001).
Concerning endocervical cellularity among all of the satisfactory samples, it was observed that 29 out of 96 conventionally obtained samples (30.2%) did not have enough endocervical cells, while 88 of 116 self-collected samples (75.9%) displayed the same, a difference which was significant (p < 0.0001). Then, 92 pairs of samples were contrasted, and endocervical presence coincided in 18 cases (19.6%). It was found that 4 out of the 22 self-samples with endocervical cells (18.2%) shifted to absence at sampling by the practitioner, while 48 out of the 70 samples without endocervical cells (68.5%) reversed to endocervical presence if obtained by the gynaecologist. The paired contrast was statistically significant (p < 0.01).
Whether the participants had undergone a cone biopsy or not was recorded. Thus, 94 had never been submitted to conization (78.3%), 21 had had one (17.5%), 4 two (3.3%) and 1 three (0.8%). Then, the possible impact of this procedure on the specimen collection quality was scrutinized. Regarding conventional sampling, 18 samples from non operated on women were unsatisfactory (19.1%) versus 6 from operated on ones (23.1%), a difference that was not significant (p = 0.78). Self-sampling also obtained similar satisfactory results, this is, none of the women who had not had this operation obtained unsatisfactory cytology versus one among the operated on women (3.8%) (p = 0.22). The presence of endocervical cells in the satisfactory samples was also studied. So, 53 of the Pap smears obtained by the clinician in the non-conization group contained them (69.7%) versus 14 of the smears performed in the conization group (70.0%) (p = 1.00). Finally, the proportions were somewhat different among the self-collected specimens, with predominating samples without endocervical cells among 24 of the operated on women (85.7%) compared to the 64 non-operated on (72.7%), although statistical significance wasn't also reached (p = 0.21).
Validity of HPV analyses and concordance among them according to the method of sampling:
Since all HPV studies were informative, the gold standard was contrasted with the results obtained with all self-sampling devices. Table 4 shows the comparisons among HPV results (negative, positive and different categories of positivity).
Table 4
Concordance of human papillomavirus analysis with the gold standard according to each device for self-sampling.
Self-sampling devices
|
Results of HPV analyses
|
Conventional sampling
|
Observed concordance for distinct comparisons (italics)*
Sensitivity (95% CI)
Specificity (95% CI)
|
Kappa coefficients (95%CI)
Weighted Kappa*
|
Negative
|
Positive
|
Positive for 16 and/or 18
|
Positive only for others
|
Total
|
Viscose
|
Negative
|
34 (55.7%)
|
5 (8.2%)
|
1 (1.6%)
|
4 (6.6%)
|
39 (63.9%)
|
52 (85.3%)
81.8% (59.7%-94.8%)
87.2% (72.6%-95.7%)
|
0.68 (0.49–0.87)
|
Positive
|
4 (6.6%)
|
18 (29.5%)
|
8 (13.1%)
|
10 (16.4%)
|
22 (36.1%)
|
Positive for 16 and/or 18
|
0 (0.0%)
|
6 (9.8%)
|
6 (9.8%)
|
0 (0.0%)
|
6 (9.8%)
|
58 (95.1%)
50 (82.0%)
|
0.77 (0.53-1.00)
0.66 (0.48–0.84)
0.63
|
Positive only for others
|
4 (6.6%)
|
12 (19.7%)
|
2 (3.3%)
|
10 (16.4%)
|
16 (26.2%)
|
Total
|
38 (62.3%)
|
23 (37.7%)
|
9 (14.8%)
|
14 (23.0%)
|
61 (100%)
|
Iune
|
Negative
|
33 (54.1%)
|
6 (9.8%)
|
1 (1.6%)
|
5 (8.2%)
|
39 (63.9%)
|
53 (86.9%)
90.9% (70.8%-98.9%)
84.6% (69.5%-94.1%)
|
0.73 (0.55–0.90)
|
Positive
|
2 (3.3%)
|
20 (32.8%)
|
9 (14.8%)
|
11 (18.0%)
|
22 (36.1%)
|
Positive for 16 and/or 18
|
0 (0.0%)
|
6 (9.8%)
|
6 (9.8%)
|
0 (0.0%)
|
6 (9.8%)
|
57 (93.4%)
50 (82.0%)
|
0.72 (0.46–0.97)
0.67 (0.50–0.84)
0.66
|
Positive only for others
|
2 (3.3%)
|
14 (23.0%)
|
3 (4.9%)
|
11 (18.0%)
|
16 (26.2%)
|
Total
|
35 (57.4%)
|
26 (42.6%)
|
10 (16.4%)
|
16 (26.2%)
|
61 (100%)
|
Viba-Brush®
|
Negative
|
32 (54.2%)
|
4 (6.8%)
|
0 (0.0%)
|
4 (6.8%)
|
36 (61.0%)
|
54 (91.5%)
95.7% (78.1%-99.9%)
88.9% (73.9%-96.9%)
|
0.83 (0.68–0.97)
|
Positive
|
1 (1.7%)
|
22 (37.3%)
|
11 (18.6%)
|
11 (18.6%)
|
23 (39.0%)
|
Positive for 16 and/or 18
|
0 (0.0%)
|
9 (15.3%)
|
9 (15.3%)
|
0 (0.0%)
|
9 (15.3%)
|
57 (96.6%)
52 (88.1%)
|
0.88 (0.72-1.00)
0.79 (0.65–0.94)
0.76
|
Positive only for others
|
1 (1.7%)
|
13 (22.0%)
|
2 (3.4%)
|
11 (18.6%)
|
14 (23.7%)
|
Total
|
33 (55.9%)
|
26 (44.1%)
|
11 (18.6%)
|
15 (25.4%)
|
59 (100%)
|
Mía by XytoTest®
|
Negative
|
33 (55.9%)
|
3 (5.1%)
|
0 (0.0%)
|
3 (5.1%)
|
36 (61.0%)
|
55 (93.2%)
95.7% (78.1%-99.9%)
91.7% (77.5%-98.3%)
|
0.86 (0.73–0.99)
|
Positive
|
1 (1.7%)
|
22 (37.3%)
|
10 (16.9%)
|
12 (20.3%)
|
23 (39.0%)
|
Positive for 16 and/or 18
|
0 (0.0%)
|
9 (15.3%)
|
9 (15.3%)
|
0 (0.0%)
|
9 (15.3%)
|
58 (98.3%)
54 (91.5%)
|
0.94 (0.82-1.00)
0.85 (0.72–0.98)
0.82
|
Positive only for others
|
1 (1.7%)
|
13 (22.0%)
|
1 (1.7%)
|
12 (20.3%)
|
14 (23.7%)
|
Total
|
34 (57.6%)
|
25 (42.4%)
|
10 (16.9%)
|
15 (25.4%)
|
59 (100%)
|
HPV: high-risk human papillomavirus. |
95% IC: 95% confidence interval. |
*The values corresponding to the comparison between positive and negative HPV tests are shown, later those HPV positive for types 16 and/or 18 versus the rest of the results and, finally, among the three possible categories (negative, positive for types 16 and/or 18, positive only for others). |
The validity measures and κ coefficients for the various devices ordered from highest to lowest are Mía by XytoTest®, Viba-Brush®, Iune and viscose. For the first two devices, the sensitivity is similar, 95.7%, although the specificity is slightly higher for Mía by XytoTest®, 91.7% versus 88.9%. The concordance is very good for both (0.86 and 0.83 respectively). On the other hand, between the last two, the decrease in sensitivity is more marked; 90.9% for Iune compared to 81.8% for viscose swab, although the specificity is better for the viscose device, that is, 87.2% compared to 84.6%. However, the concordance is reasonable for both (0.73 and 0.68 respectively). It is interesting to note that the contrast between the positive assays for HPV types 16 and/or 18 and the rest improves the values for all the devices but Iune, reaching a maximum value of 0.94 for Mía by XytoTest®.
Concordance among liquid cytology results according to sampling method:
A statistical analysis was performed on the informative samples, whose figures and results of the κ coefficients are depicted in Table 5. The smear interpretation was grouped into three categories, that is, negative for intraepithelial lesion or malignancy; ASC-US (atypical squamous cells of undetermined significance) and LSIL (low-grade squamous intraepithelial lesion); ASC-H (atypical squamous cells, cannot exclude high-grade intraepithelial lesion), atypical glandular cells, and HSIL (high-grade squamous intraepithelial lesion). As it may be seen, the values are higher for Viba-Brush® than for Mía by Xytotest® (weighted κ of 0.43 and 0.30, respectively), and correspond to moderate and fair agreements respectively. The contrast between negative results versus the group including ASC-US and dysplasia showed slightly higher values, that is, κ of 0.51 for Viba-Brush® and 0.41 for Mía by Xytotest®. However, the specificity values were identical for both devices, i.e., 84.6%, but the sensitivity figures were slightly higher for Viba-Brush® than for Mía by Xytotest®, i.e., 95.0% versus 84.6%.
Table 5
Concordance of cytological analysis with the gold standard according to each device for self-sampling.
Self-sampling devices
|
Results of the cytological analysis
|
Conventional sampling
|
Observed concordance for distinct comparison (italics)*
Sensitivity (95% CI)
Specificity (95% CI)
|
Kappa coeficient (95%CI)
Weighted Kappa*
|
Negative
|
Positive
|
ASC-US or LSIL
|
ASC-H, AGC or HSIL
|
Total
|
Viba-Brush®
|
Negative
|
22 (47.8%)
|
7 (15.2%)
|
7 (15.2%)
|
0 (0.0%)
|
29 (63.0%)
|
35 (76.1%)
95.0% (40.8%-84.6%)
84.6% (65.1%-95.6%)
|
0.51 (0.25–0.76)
|
Positive
|
4 (8.7%)
|
13 (28.3%)
|
11 (23.9%)
|
2 (4.3%)
|
17 (37.0%)
|
ASCUS or LSIL
|
4 (8.7%)
|
13 (28.3%)
|
11 (23.9%)
|
2 (4.3%)
|
17 (37.0%)
|
33 (71.7%)
|
0.43 (0.19–0.68) 0.46
|
ASC-H, AGC or HSIL
|
0 (0.0%)
|
0 (0.0%)
|
0 (0.0%)
|
0 (0.0%)
|
0 (0.0%)
|
Total
|
26 (56.5%)
|
20 (43.5%)
|
18 (39.1%)
|
2 (4.4%)
|
46 (100%)
|
Mía by XytoTest®
|
Negative
|
22 (47.8%)
|
9 (19.6%)
|
9 (19.6%)
|
0 (0.0%)
|
31 (67.4%)
|
33 (71.7%)
84.6% (65.1%-95.6%)
55.0% (31.58%-76.9%)
|
0.41 (0.15–0.67)
|
Positive
|
4 (8.7%)
|
11 (23.9%)
|
9 (19.6%)
|
2 (4.3%)
|
15 (32.6%)
|
ASCUS or LSIL
|
4 (8.7%)
|
10 (21.7%)
|
8 (17.4%)
|
2 (4.3%)
|
14 (30.4%)
|
30 (65.2%)
|
0.30 (0.06–0.55) 0.36
|
ASC-H, AGC or HSIL
|
0 (0.0%)
|
1 (2.2%)
|
1 (2.2%)
|
0 (0.0%)
|
1 (2.2%)
|
Total
|
26 (56.5%)
|
20 (43.5%)
|
18 (39.1%)
|
2 (4.3%)
|
46 (100%)
|
ASC-US: atypical squamous cells of undetermined significance. |
LSIL: low-grade squamous intraepithelial lesion.
ASC-H: atypical squamous cells, cannot exclude high-grade intraepithelial lesion.
AGC: atypical glandular cells.
HSIL: high-grade squamous intraepithelial lesion.
95% IC: 95% confidence interval.
*Firstly, the values corresponding to the comparison between positive and negative Pap smears are shown, later those among three categories (negative; ASC-US and LSIL; ASC-H, AGC and HSIL).
The health repercussions of using the patient-collected samples instead of the conventional ones were also explored. For this, the algorithm established in the corresponding Spanish rules was applied1 (Fig. 3).
Negative repercussions of self-sampling were defined as one or more indications for referral to colposcopy according to the conventional sampling that did not correspond to a similar indication after self-sampling, that is:
-
A negative HPV result from self-sampling and a positive result for 16 and/or 18 HPV types from conventional sampling.
-
A conventional cytological result of HSIL, ASC-H or AGC and lack of indication for referral in the same year according to the paired self-collected sample.
It was observed that there were no negative repercussions for the devices, but for the viscose one, on account of a single self-taken specimen that was negative for HPV while the corresponding conventional one exhibited the results of HPV positive for other types and a cytological HSIL.
Self-sampling women’s reporting:
All 120 participants were asked if they knew that self-sampling could be used for the early detection of cervical cancer, and the answer was unanimously negative. We continued by asking the women to allocate the self-collection in three categories; thus, for 110, it was an advantage (91.7%), for 7, neither advantage nor disadvantage (5.8%), and for 3, an inconvenience (2.5%). The last three justified their answer by wanting the professional to take the sample, two of them feared they would not do well, and the third thought she might get hurt.
The 110 participants who rated the self-collection as advantageous were asked to select one or more reasons for their rating. The benefits invoked, from highest to lowest frequency, were: schedule or not depending on the timetable of the health centre nor the menses (66/110; 60.0%); comfort or being able to choose the time and place of the sampling (also 66/110; 60.0%); intimacy or preference not to expose the genitals to the health staff (42/110; 38.2%); fear of suffering pain or discomfort while being sampled by the clinician (24/110; 21.8%); and others (6/110; 5.5%).
In addition, they were inquired if they were or not familiar with the use of menstrual care devices (tampons and/or menstrual cups), with 90 women responding in the affirmative (75%) and 30 in the negative (25%). Of the 90 users of period products, 85 rated self-collection as an advantage (94.4%), while among the 30 non-users, 25 also rated it favourably (83.3%). The difference between the two proportions did not reach statistical significance (p = 0.1866).
Once the self-collection was over, they were requested if they had noticed any pain or discomfort. Ninety-one participants answered no (75.8%), and 29 said yes (24.2%). With respect to age influencing the rating, it was observed that the median age for the group considering the sampling annoying and/or painful was 44 years old (39–52) and 48 years old (42–51) for those who noticed no discomfort or pain, differences which were not significant (p = 0.1738). The stated causes of pain and/or discomfort were vaginal dryness associated with menopause, breastfeeding, contraception or just passed menstrual bleeding; the discomfort of the hospital toilet (space, cleanliness, difficulty hanging clothes or bag); comorbidities such as osteoarthritis of the hands or fibromyalgia; ignorance of vaginal anatomy; or preferring to take the sample at home and being able to change body position during sampling. We asked if they had had difficulty performing the self-collection, so 116 had no difficulty performing it (96.7%), while the remaining 4 (3.3%) did. Of the last four, two had been assigned to dry and two to liquid devices. They were between 46 and 63 years old and reported pain and/or discomfort. Three were unfamiliar with the use of vaginal period products, two reported common discomfort during gynaecological examinations and one reported difficulty in interpreting the instructions. Still, all four considered self-collection as an advantage.
Finally, they were asked if they would request self-sampling on another occasion, obtaining an affirmative answer in 102 women (85.0%), a negative in 16 (13.3%) and an indeterminate one for the remaining 2 (1.7%). Of the 16 who said no, 14 argued they relied more on sampling by the practitioner. One commented that self-collection was a pretext to depersonalize care and avoid contact with patients and the second alluded to the side benefits of face-to-face visits (visual inspection, possibility of getting informed about gynaecological issues). Other arisen aspects were the possible obstacles linked to pelvic floor disorders, the alleged duplication of care if a woman frequented the gynaecology offices for reasons other than screening, the concern of becoming infected while self-sampling if the woman is immunocompromised and laziness to read the instructions. The answer was segmented according to age and educational level. Thus, 53 women (93.0%) under 46 would resort to self-collection again compared to 49 (77.8%) of the oldest, a difference that was statistically significant (p = 0.0226). Concerning the level of education, 30 of 38 women (78.9%) who had primary school or lower would ask for self-sampling again versus 72 of 82 (87.8%) with higher education. However, the disparity between the two proportions was not significant (p = 0.2715).
Device preferences:
The order of choice of the device was recorded for 119 participants, 60 of whom used the viscose and Iune devices, and 59 the Viba-Brush® and the Mía by Xytotest®. Table 6 specifies preferences, absolute numbers, and percentages in-depth.
Table 6
Devices for self-samples ordered from highest to lowest preference of participants*.
Device
|
Group viscose and Iune (n = 60)
|
Group Viba-Brush® and Mía by Xytotest® (n = 59)
|
Totals
|
1st preference
|
Viscose
|
38 (63.3%)
|
4 (6.8%)
|
42 (35.3%)
|
Iune
|
17 (28.3%)
|
7 (11.9%)
|
24 (20.2%)
|
Mía by Xytotest®
|
2 (3.3%)
|
45 (76.3%)
|
47 (39.5%)
|
Viba-Brush®
|
3 (5.0%)
|
3 (5.1%)
|
6 (5.0%)
|
Total
|
60 (100%)
|
59 (100%)
|
119 (100%)
|
|
2nd preference
|
Viscose
|
12 (20.0%)
|
21 (35.6%)
|
33 (27.7%)
|
Iune
|
20 (33.3%)
|
12 (20.3%)
|
32 (26.9%)
|
Mía by Xytotest®
|
18 (30.0%)
|
11 (18.6%)
|
29 (24.4%)
|
Viba-Brush®
|
10 (16.7%)
|
15 (25.4%)
|
25 (21.0%)
|
Total
|
60 (100%)
|
59 (100%)
|
119 (100%)
|
|
3rd preference
|
Viscose
|
6 (10.0%)
|
18 (30.5%)
|
24 (20.2%)
|
Iune
|
12 (20.0%)
|
24 (40.7%)
|
36 (30.3%)
|
Mía by Xytotest®
|
27 (45.0%)
|
3 (5.1%)
|
30 (25.2%)
|
Viba-Brush®
|
15 (25.0%)
|
14 (23.7%)
|
29 (24.4%)
|
Total
|
60 (100%)
|
59 (100%)
|
119 (100%)
|
|
4th preferencia
|
Viscose
|
4 (6.7%)
|
16 (27.1%)
|
20 (16.8%)
|
Iune
|
11 (18.3%)
|
16 (27.1%)
|
27 (22.7%)
|
Mía by Xytotest®
|
13 (21.7%)
|
0 (0.0%)
|
13 (10.9%)
|
Viba-Brush®
|
32 (53.3%)
|
27 (45.8%)
|
59 (49.6%)
|
Total
|
60 (100%)
|
59 (100%)
|
119 (100%)
|
* The highest figures have been highlighted in bold. |
Due to the similarity between Viba-Brush® and Cervex-Brush®, participants were told that Viba-Brush® would probably get the same quality of conventionally collected specimens. As a result, they were asked if, in the case that they had not prioritized Viba-Brush®, they would swap to it to get a better cervicovaginal specimen. Of the 114 women who did not first choose Viba-Brush®, 108 (94.7%) accepted the change, and the remaining 6 (5.3%) did not.