Fahey M T, Irwig L, Macaskill P
Department of Public Health, University of Sydney, New South Wales, Australia.
Am J Epidemiol. 1995 Apr 1;141(7):680-9. doi: 10.1093/oxfordjournals.aje.a117485.
A literature search identified 62 studies published by August 1992 comparing Papanicolaou (Pap) test results with histology. Critical appraisal revealed that 82% of these had potential for verification bias and that only 37% stated that cytology and histology were independently assessed. Estimates of sensitivity and specificity ranged from 11 to 99% and 14 to 97%, respectively, and were highly negatively correlated (r = -0.63). Meta-analysis was used to combine data from 59 studies to estimate the accuracy of the Pap test using a summary receiver operating characteristic curve and to examine the effect of study quality. The summary receiver operating characteristic curve suggests that the Pap test may be unable to achieve concurrently high sensitivity and specificity. For example, specificity in the 90-95% range corresponds to sensitivity in the 20-35% range. Pap test accuracy was not associated with reported study characteristics or dimensions of quality. Future primary studies should pay more attention to methodologic standards for the conduct and reporting of diagnostic test evaluations.
一项文献检索发现，截至1992年8月共发表了62项比较巴氏试验结果与组织学结果的研究。严格评估显示，其中82%的研究存在验证偏倚的可能性，只有37%的研究表明细胞学和组织学是独立评估的。敏感性和特异性的估计值分别在11%至99%和14%至97%之间，且呈高度负相关（r = -0.63）。采用Meta分析合并59项研究的数据，通过汇总接受者操作特征曲线估计巴氏试验的准确性，并检验研究质量的影响。汇总接受者操作特征曲线表明，巴氏试验可能无法同时实现高敏感性和高特异性。例如，特异性在90%至95%范围内时，敏感性在20%至35%范围内。巴氏试验的准确性与报告的研究特征或质量维度无关。未来的原发性研究应更加关注诊断试验评估实施和报告的方法学标准。
