Smith Sabrina K, Nwosu Oguchi, Edwards Alex, Zerihun Meseret, Chung Michael H, Suvada Kara, Ali Mohammed K
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America.
PLOS Glob Public Health. 2023 Feb 23;3(2):e0001598. doi: 10.1371/journal.pgph.0001598. eCollection 2023.
To evaluate the performance of visual inspection with acetic acid (VIA) testing, visual inspection with Lugol's iodine (VILI), primary HPV testing, and conventional Pap smear in detecting CIN2+ among non-pregnant women aged 30-65 in LMICs between 1990 and 2020.
Systematic review and meta-analysis.
Low- and middle-income countries, non-pregnant women aged 30-65.
CENTRAL (Cochrane Library), CINAHL, Embase, Global Health, PubMed, and Web of Science databases were systematically searched to identify studies evaluating the performance of cervical cancer screening methods in LMICs. A diagnostic test accuracy meta-analysis was conducted to evaluate the performance of 4 screening methods in detecting CIN2+ relative to biopsy or cytology reference standards. Pooled statistics for sensitivity, specificity, diagnostic odds ratios, and summary receiver operating characteristic curves were determined for each method. Subgroup analyses were performed to examine whether there was variation in performance based on different reference standards for defining CIN2+, specifically: colposcopy-directed biopsy, biopsy alone, colposcopy alone, or liquid-based cytology.
Eighteen studies were identified through systematic review. Twelve studies were included in meta-analysis; 11 were cross-sectional and 1 was a randomized controlled clinical trial. The remaining six of the eighteen studies were inclided in a narrative syntehsis. Pooled estimates for sensitivity for VIA, VILI, primary HPV testing, and conventional Pap smear were 72.3%, 64.5%, 79.5%, and 60.2%, respectively; pooled estimates for specificity were 74.5%, 68.5%, 72.6%, and 97.4%, respectively; the diagnostic odds ratios were 7.31, 3.73, 10.42, 69.48, respectively; and the area under the summary receiver operating characteristic curves were 0.766, 0.647, 0.959, and 0.818, respectively. Performance of the screening method varied based on the reference standard used; pooled estimates using either colposcopy-directed biopsy or biopsy alone as the reference standard generally reported lower estimates; pooled estimates using either colposcopy alone or liquid-based cytology as references reported higher estimates.
This meta-analysis found primary HPV testing to be the highest performing cervical cancer screening method in accurately identifying or excluding CIN2+. Further evaluation of performance at different CIN thresholds is warranted.
评估1990年至2020年间，在低收入和中等收入国家（LMICs）30至65岁非妊娠女性中，醋酸肉眼观察法（VIA）检测、卢戈氏碘肉眼观察法（VILI）、HPV初筛检测和传统巴氏涂片检查在检测高级别宫颈上皮内瘤变（CIN2+）方面的性能。
系统评价和荟萃分析。
低收入和中等收入国家，30至65岁非妊娠女性。
系统检索CENTRAL（考克兰图书馆）、CINAHL、Embase、Global Health、PubMed和Web of Science数据库，以确定评估LMICs宫颈癌筛查方法性能的研究。进行诊断试验准确性荟萃分析，以评估4种筛查方法相对于活检或细胞学参考标准在检测CIN2+方面的性能。确定每种方法的敏感性、特异性、诊断比值比和汇总受试者工作特征曲线下面积的合并统计量。进行亚组分析，以检查基于定义CIN2+的不同参考标准（具体为：阴道镜引导下活检、单纯活检、单纯阴道镜检查或液基细胞学检查），筛查方法的性能是否存在差异。
通过系统评价确定了18项研究。12项研究纳入荟萃分析；11项为横断面研究，1项为随机对照临床试验。18项研究中的其余6项纳入叙述性综合分析。VIA、VILI、HPV初筛检测和传统巴氏涂片检查的敏感性合并估计值分别为72.3%、64.5%、79.5%和60.2%；特异性合并估计值分别为74.5%、68.5%、72.6%和97.4%；诊断比值比分别为7.31、3.73、10.42和69.48；汇总受试者工作特征曲线下面积分别为0.766、0.647、0.959和0.818。筛查方法的性能因所使用的参考标准而异；以阴道镜引导下活检或单纯活检作为参考标准的合并估计值通常较低；以单纯阴道镜检查或液基细胞学检查作为参考标准的合并估计值较高。
本荟萃分析发现，HPV初筛检测是在准确识别或排除CIN2+方面性能最高的宫颈癌筛查方法。有必要对不同CIN阈值下的性能进行进一步评估。
