Hermens Marjolein, Ebisch Renée M F, Galaal Khadra, Bekkers Ruud L M
Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands; and the Department of Gynaecological Oncology, Royal Cornwall Hospital Trust, Truro, United Kingdom.
Obstet Gynecol. 2016 Oct;128(4):795-803. doi: 10.1097/AOG.0000000000001613.
OBJECTIVE: To assess the diagnostic value of alternative (digital) colposcopy techniques for detection of cervical intraepithelial neoplasia (CIN) 2 or worse in a colposcopy population. DATA SOURCES: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Library were searched from inception up to January 11, 2016, for studies that evaluated the diagnostic value of alternative (digital) colposcopy techniques. METHODS OF STUDY SELECTION: Inclusion criteria were: 1) an alternative (digital) colposcopy technique was used in a colposcopy population; 2) a histologic outcome was reported, classified as CIN, differentiating between mild dysplasia or less (CIN 1 or less), and moderate dysplasia or worse (CIN 2 or greater); 3) the entire cervix was scanned at once or a per-woman analysis was performed; 4) no other topical application than acetic acid and Lugol's solution was used; 5) at least three eligible studies had to be available within a single technique; and 6) studies obtained research ethics approval. Language was restricted to English. TABULATION, INTEGRATION, AND RESULTS: Two reviewers assessed the eligibility of the identified articles. Disagreements were resolved by a third reviewer. Thirteen studies met the inclusion criteria. We found six studies on fluorescence and reflectance spectroscopy, including 2,530 women, with a pooled sensitivity of 93% (95% confidence interval [CI] 89-95%) and specificity of 62% (95% CI 47-76%). Four studies on dynamic spectral imaging were found including 1,173 women with a pooled sensitivity of 69% (95% CI 48-85%) and specificity of 83% (95% CI 76-88%). We found three studies on optical coherence tomography including 693 women with a pooled sensitivity of 48% (95% CI 32-64%) and specificity of 77% (95% CI 52-91%). Previously published conventional colposcopy results showed a sensitivity of 61% (95% CI 58-63%) and a specificity of 85% (95% CI 83-86%). CONCLUSION: Alternative (digital) colposcopy techniques may result in increased sensitivity and specificity, but no recommendation for introduction in clinical practice can be made yet.
目的：评估替代（数字）阴道镜检查技术在阴道镜检查人群中检测宫颈上皮内瘤变（CIN）2级或更高级别病变的诊断价值。 数据来源：检索MEDLINE、EMBASE、ClinicalTrials.gov和Cochrane图书馆，检索时间从建库至2016年1月11日，查找评估替代（数字）阴道镜检查技术诊断价值的研究。 研究选择方法：纳入标准为：1）在阴道镜检查人群中使用了替代（数字）阴道镜检查技术；2）报告了组织学结果，分类为CIN，区分轻度发育异常或更低级别（CIN 1或更低）和中度发育异常或更高级别（CIN 2或更高）；3）对整个宫颈进行一次性扫描或进行每位女性的分析；4）除醋酸和卢戈氏碘液外未使用其他局部应用；5）单一技术内至少有三项符合条件的研究；6）研究获得了研究伦理批准。语言限于英语。 制表、整合及结果：两名评审员评估了所识别文章的合格性。分歧由第三名评审员解决。13项研究符合纳入标准。我们发现了6项关于荧光和反射光谱的研究，包括2530名女性，合并敏感度为93%（95%置信区间[CI] 89 - 95%），特异度为62%（95% CI 47 - 76%）。发现了4项关于动态光谱成像的研究，包括1173名女性，合并敏感度为69%（95% CI 48 - 85%），特异度为83%（95% CI 76 - 88%）。我们发现了3项关于光学相干断层扫描的研究，包括693名女性，合并敏感度为48%（95% CI 32 - 64%），特异度为77%（95% CI 52 - 91%）。先前发表的传统阴道镜检查结果显示敏感度为61%（95% CI 58 - 63%），特异度为85%（95% CI 83 - 86%）。 结论：替代（数字）阴道镜检查技术可能会提高敏感度和特异度，但目前尚不能推荐将其引入临床实践。
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