- Volume 16 Issue 14
DOI QR Code
Accuracy of Combined Visual Inspection with Acetic Acid and Cervical Cytology Testing as a Primary Screening Tool for Cervical Cancer: a Systematic Review and Meta-Analysis
- Chanthavilay, Phetsavanh ;
- Mayxay, Mayfong ;
- Phongsavan, Keokedthong ;
- Marsden, Donald E ;
- White, Lisa J ;
- Moore, Lynne ;
- Reinharz, Daniel
- Published : 2015.09.02
Background: The performance of combined testing visual inspection with acetic acid (VIA) and cervical cytology tests might differ from one setting to another. The average estimate of the testing accuracy across studies is informative, but no meta-analysis has been carried out to assess this combined method. Objective: The objective of this study was to estimate the average sensitivity and specificity of the combined VIA and cervical cytology tests for the detection of cervical precancerous lesions. Materials and Methods: We conducted a systematic review and a meta-analysis, according to the Cochrane Handbook for Systematic Review of Diagnostic Test Accuracy. We considered two cases. In the either-positive result case, a positive result implies positivity in at least one of the tests. A negative result implies negativity in both tests. In the both-positive case, a positive result implies having both tests positive. Eligible studies were identified using Pubmed, Embase, Website of Science, CINHAL and COCRANE databases. True positive, false positive, false negative and true negative values were extracted. Estimates of sensitivity and specificity, positive and negative likelihood (LR) and diagnostic odds ratios (DOR) were pooled using a hierarchical random effect model. Hierarchical summary receiver operating characteristics (HSROC) were generated and heterogeneity was verified through covariates potentially influencing the diagnostic odds ratio. Findings: Nine studies fulfilled inclusion criteria and were included in the analysis. Pooled estimates of the sensitivities of the combined tests in either-positive and both-positive cases were 0.87 (95% CI: 0.83-0.90) and 0.38 (95% CI: 0.29-0.48), respectively. Corresponding specificities were 0.79 (95% CI: 0.63-0.89) and 0.98 (95% CI: 0.96-0.99) respectively. The DORs of the combined tests in either-positive or both-positive result cases were 27.7 (95% CI: 12.5-61.5) and 52 (95% CI: 22.1-122.2), respectively. When including only articles without partial verification bias and also a high-grade cervical intraepithelial neoplasia as a threshold of the disease, DOR of combined test in both-positive result cases remained the highest. However, DORs decreased to 12.1 (95% CI: 6.05-24.1) and 13.8 (95% CI: 7.92-23.9) in studies without partial verification bias for the combined tests in the either-positive and both-positive result cases, respectively. The screener, the place of study and the size of the population significantly influenced the DOR of combined tests in the both-positive result case in restriction analyses that considered only articles with CIN2+ as disease threshold. Conclusions: The combined test in the either-positive result case has a high sensitivity, but a low specificity. These results suggest that the combined test should be considered in developing countries as a primary screening test if facilities exist to confirm, through colposcopy and biopsy, a positive result.
Screening test performance;combined test;cervical cytology;VIA;developing countries
- Arbyn M, Sankaranarayanan R, Muwonge R, et al (2008). Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer, 123, 153-60. https://doi.org/10.1002/ijc.23489
- Bossuyt P, Davenport C, Deeks J, et al (2013). Chapter 11 Interpreting results and drawing conclusions. In 'Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy version 9', Eds The Cochrane Collaboration,
- Chen C, Yang Z, Li Z, et al (2012). Accuracy of several cervical screening strategies for early detection of cervical cancer: a meta-analysis. Int J Gynecol Cancer, 22, 908-21. https://doi.org/10.1097/IGC.0b013e318256e5e4
- Consul S, Agrawal A, Sharma H, et al (2012). Comparative study of effectiveness of Pap smear versus visual inspection with acetic acid and visual inspection with Lugol's iodine for mass screening of premalignant and malignant lesion of cervix. Indian J Med Paediatr Oncol, 33, 161-5. https://doi.org/10.4103/0971-5851.103143
- de Groot JA, Bossuyt PM, Reitsma JB, et al (2011). Verification problems in diagnostic accuracy studies: consequences and solutions. BMJ, 343, 4770. https://doi.org/10.1136/bmj.d4770
- Deeks JJ, Bossuyt PM, Gatsonis C 2010. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0.0., The Cochrane Collaboration.
- Denny L, Quinn M, Sankaranarayanan R (2006). Chapter 8: Screening for cervical cancer in developing countries. Vaccine, 24, 71-7. https://doi.org/10.1016/j.vaccine.2006.05.121
- Echelman D, Feldman S (2012). Management of cervical precancers: a global perspective. Hematol Oncol Clin North Am, 26, 31-44. https://doi.org/10.1016/j.hoc.2011.11.005
- Ferlay J, Soerjomataram I, Dikshit R, et al (2014). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136, 359-86.
- FIGO (2009). Global Guidance for Cervical Cancer Prevention and Control.
- Harbord RM, Whiting P (2009). metandi: Meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata J, 9, 211-29.
- Jacob M (2009). HPV Vaccines: Characteristics, target population and safety. in 'global guidance for cervical cancer prevention and control', Eds International Federation of Gynecology and Obstetrics, 15-9
- Kay M (2013). Screening with acetic acid could prevent 22 000 deaths from cervical cancer in India every year. BMJ, 346, 3935. https://doi.org/10.1136/bmj.f3935
- Liberati A, Altman DG, Tetzlaff J, et al (2009). The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 62, 1-34. https://doi.org/10.1016/j.jclinepi.2008.07.007
- Macaskill P, Gatsonis C, Deeks JJ, et al (2010). Chapter 10: analysing and presenting results. In 'Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy', Eds The Cochrane Collaboration,
- Mitchell MF, Schottenfeld D, Tortolero-Luna G, et al (1998). Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol, 91, 626-31. https://doi.org/10.1016/S0029-7844(98)00006-4
- Nanda K, McCrory DC, Myers ER, et al (2000). Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med, 132, 810-9. https://doi.org/10.7326/0003-4819-132-10-200005160-00009
- Naucler P, Ryd W, Tornberg S, et al (2009). Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. J Natl Cancer Inst, 101, 88-99. https://doi.org/10.1093/jnci/djn444
- Sankaranarayanan R, Thara S, Sharma A, et al (2004). Accuracy of conventional cytology: results from a multicentre screening study in India. J Med Screen, 11, 77-84. https://doi.org/10.1258/096914104774061056
- Saslow D, Solomon D, Lawson HW, et al (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin, 62, 147-72. https://doi.org/10.3322/caac.21139
- Sauvaget C, Fayette JM, Muwonge R, et al (2011). Accuracy of visual inspection with acetic acid for cervical cancer screening. Int J Gynaecol Obstet, 113, 14-24. https://doi.org/10.1016/j.ijgo.2010.10.012
- Sherris J, Wittet S, Kleine A, et al (2009). Evidence-based, alternative cervical cancer screening approaches in lowresource settings. Int Perspect Sex Reprod Health, 35, 147-54. https://doi.org/10.1363/3514709
- Sideri M, Schettino F, Spinaci L, et al (1995). Operator variability in disease detection and grading by colposcopy in patients with mild dysplastic smears. Cancer, 76, 1601-5. https://doi.org/10.1002/1097-0142(19951101)76:9<1601::AID-CNCR2820760916>3.0.CO;2-Z
- Vedantham H, Silver MI, Kalpana B, et al (2010). Determinants of VIA (Visual Inspection of the Cervix After Acetic Acid Application) positivity in cervical cancer screening of women in a peri-urban area in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev, 19, 1373-80. https://doi.org/10.1158/1055-9965.EPI-09-1282
- Vesco KK, Whitlock EP, Eder M, et al 2011. Screening for Cervical Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force, Rockville MD.
- Whiting PF, Rutjes AW, Westwood ME, et al (2011). QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 155, 529-36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009
- World Bank (2014). Country and lending groups.
- Economic Evaluation of Screening Strategies Combined with HPV Vaccination of Preadolescent Girls for the Prevention of Cervical Cancer in Vientiane, Lao PDR vol.11, pp.9, 2016, https://doi.org/10.1371/journal.pone.0162915