Performance of Screening Tools for Cervical Neoplasia Among Women in Low- and Middle-income Countries: A Systematic Review and Meta-Analysis Público
Smith, Sabrina (Spring 2021)
Abstract
Introduction: Cervical cancer continues to be a public health threat worldwide, disproportionately affecting low- and middle-income countries (LMICs). Screening for cervical cancer allows for early detection and treatment. Given the context of limited resources and challenges of traditional screening via Pap smears, the performance of different screening methods needs further evaluation.
Objective/Aim: This systematic review and meta-analysis evaluates 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 cervical intraepithelial neoplasia grade 2 or greater (CIN2+) among non-pregnant women aged 30-65 in LMICs between 1990 and 2020.
Methods: CENTRAL, CINAHL, Embase, Global Health, PubMed and Web of Science databases were systematically searched to identify studies. Diagnostic test accuracy meta- analysis evaluated the performance of screening methods in detecting CIN2+. Summary statistics for sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver operating characteristic (SROC) curves were determined for each method. Subgroup analyses were performed to examine whether there was variation in performance based on different reference standards, specifically: colposcopy-directed biopsy, biopsy alone, colposcopy alone, or liquid-based cytology.
Results: Eighteen studies were identified through systematic review. Six were narratively synthesized and excluded from meta-analysis given limitations in outcome values reported. Of the 12 studies included in meta-analysis, 11 were cross-sectional and 1 was a randomized controlled clinical trial. Summary estimates for sensitivity for VIA, VILI, HPV, and conventional Pap smear were 72.3%, 64.5%, 79.5%, and 60.2%, respectively; summary estimates for specificity were 74.5%, 68.5%, 72.6%, and 97.4%, respectively; the DORs were 7.31, 3.73, 10.42, 69.48, respectively; and the area under the SROC curves were 0.766, 0.647, 0.959, and 0.818, respectively. Performance of screening method varied based on reference standard used; summary estimates using colposcopy- directed biopsy or biopsy generally reported lower estimates; summary estimates using colposcopy or liquid-based cytology generally reported higher estimates.
Conclusion: This meta-analysis found primary HPV testing and VIA to be the highest performing cervical cancer screening methods in accurately identifying or excluding CIN2+. In resource-constrained countries, VIA may be the most feasible screening method. Further evaluation of performance at different CIN thresholds is warranted.
Table of Contents
INTRODUCTION
Introduction & Rationale
Problem Statement
Purpose Statement
Objectives and Aims
Significance Statement
Definition of Terms
LITERATURE REVIEW
Burden of Cervical Cancer
Risk Factors for Cervical Cancer
Screening Methods
VIA as an Alternative Approach to Cytology Screening in LMICs
Knowledge Gap
Conclusion
STUDENT CONTRIBUTION
JOURNAL ARTICLE
Title Page
Abstract
Introduction
Methods
Results
Discussion
Conclusions and Implications
References
Tables and Figures
PUBLIC HEALTH IMPLICATIONS
REFERENCES
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Palavra-chave | |
| Committee Chair / Thesis Advisor |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Performance of Screening Tools for Cervical Neoplasia Among Women in Low- and Middle-income Countries: A Systematic Review and Meta-Analysis () | 2021-05-03 12:41:17 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|