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Accuracy of Several Cervical Screening Strategies for Early Detection of Cervical Cancer: A Meta-Analysis

Chen, Changxian MD; Yang, Zhijun PhD; Li, Zhuang MD; Li, Li PhD

International Journal of Gynecological Cancer: July 2012 - Volume 22 - Issue 6 - p 908–921
doi: 10.1097/IGC.0b013e318256e5e4
Review

Objective: The objectives of this study were to assess the accuracy of 6 common cervical screening strategies, including visual inspection with acetic acid, with a magnifying device, or with Lugol iodine (VILI), human papillomavirus testing with Hybrid Capture 2 assay, conventional Papanicolaou smear, and thin liquid-based cytology (LBC), and then to compare data obtained by the aforementioned 6 strategies.

Methods: PubMed, EMBASE, and The Cochrane Library were systematically searched for all original relevant studies about early detection of cervical cancer. A meta-analysis was performed to evaluate the accuracy of the 6 screening strategies covering sensitivity, specificity, diagnostic odds ratio, and the area under the receiver operating characteristic curve.

Results: Fifteen articles containing 22 cross-sectional studies were finally identified. The combined estimates of sensitivity for visual inspection with acetic acid, magnified visual inspection with acetic acid, VILI, Hybrid Capture 2 assay, conventional Papanicolaou smear, and LBC were 77%, 64%, 91%, 74%, 59%, and 88%, respectively; the combined values of specificity of these screening strategies were 87%, 86%, 85%, 92%, 94%, and 88%, respectively; the diagnostic odds ratio were 22.43, 10.30, 57.44, 33.26, 22.49, and 51.56, respectively; and the area under the receiver operating characteristic curve were 0.8918, 0.7737, 0.9365, 0.9486, 0.9079, and 0.9418, respectively.

Conclusions: This meta-analysis suggests that LBC appeared to be promising in primary cervical cancer screening in resourced regions, and VILI might be a good choice to identify/exclude cervical cancerous and precancerous lesions in resource-constrained regions.

Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.

Address correspondence and reprint requests to Li Li, PhD, Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, No. 71 Hedi Rd, Nanning 530021 China. E-mail: lili@gxmu.edu.cn.

The authors declare that there were no conflicts of interest.

Received January 11, 2012

Accepted March 22, 2012

Copyright © 2012 by IGCS and ESGO