Systematic Review and Meta-Analysis of Individual Patient Data to Assess the Sensitivity of Cervical Cytology for Diagnosis of Cervical Cancer in Low- and Middle-Income Countries

Castañón, Alejandra; Landy, Rebecca; Michalopoulos, Dimitrios; Bhudia, Roshni; Leaver, Hannah; Qiao, You Lin; Zhao, Fen; Sasieni, Peter

doi:10.1200/jgo.2016.008011

Cited by 6 publications

(6 citation statements)

References 26 publications

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“… 24 The systematic review and meta-analysis in low and middle-income countries included more than 700 cervical cancers from 23 studies and found pooled sensitivity of cytology for cancer 79.4% at a cut-off HSIL+. 34 On the other hand, Greek study authors reported about a very low sensitivity of cytology, 13.6% at cut-off HSIL. 35 …”

Section: Discussionmentioning

confidence: 98%

Long term results of follow-up after HPV self-sampling with devices Qvintip and HerSwab in women non-attending cervical screening programme

Bokan¹,

Ivanuš

Jerman

et al. 2021

Radiology and Oncology

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BackgroundWe are presenting the results of the Slovenian human papillomaviruses (HPV) self-sampling pilot study in colposcopy population of National Cervical Cancer Screening Programme ZORA for the first time. One-year and four-year follow-up results are presented for two different self-sampling devices.Participants and methodsA total of 209 women were enrolled in the study at colposcopy clinic. Prior to the gynaecological examination, all women performed self-collected vaginal swab at the clinic; 111 using Qvintip and 98 using HerSwab self-sampling device. After self-sampling, two cervical smears were taken by a clinician; first for conventional cytology and second for HPV test. After that, all women underwent colposcopy and a cervical biopsy if needed. We compared sensitivity, specificity, and predictive values of cytology (at the cut-off atypical squamous cells of undetermined significance or more [ASC-US+]) and HPV test (on self- and clinician-taken samples) for the detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) after one and four years of follow-up. Hybrid Capture 2 (HC2) assay was used for all HPV testing.ResultsThe mean age of 209 women was 37.6 years and HPV positivity rate 67.0% (140/209), 36.9 years and 70.3% (78/111) in the Qvintip group and 38.4 years and 63.3% (62/98) in the HerSwab group, respectively. Overall, percent agreement between self and clinician-taken samples was 81.8% (kappa 0.534) in the Qvintip and 77.1% (kappa 0.456) in the HerSwab group. In the Qvintip group, the longitudinal sensitivity, specificity, positive and negative predictive values were 71.8%, 75.0%, 83.6%, 60.0% for cytology; 83.1%, 51.3%, 75.6% and 62.5% for HPV test of self-taken samples and 94.4%, 57.5%, 79.8% and 85.2% for HPV test on clinician-taken samples. In the HerSwab group, the corresponding results were 71.7%, 46.7%, 61.3%, 58.3% for cytology; 75.0%, 47.7%, 62.9% and 61.8% for HPV test on self-taken samples and 94.3%, 44.4%, 66.7% and 87.0% for clinician-taken samples, respectively.ConclusionsThe results confirm that HPV self-sampling is not as accurate as clinician sampling when HC2 is used. All HPV tests showed a higher sensitivity in detecting CIN2+ compared to cytology. Due to non-inferior longitudinal sensitivity of HPV self-sampling compared to cytology, HPV self-sampling might be an option for non-attenders to the National Cancer Screening Programme.

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Section: Discussionmentioning

confidence: 98%

Long term results of follow-up after HPV self-sampling with devices Qvintip and HerSwab in women non-attending cervical screening programme

Bokan¹,

Ivanuš

Jerman

et al. 2021

Radiology and Oncology

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“…Triage with cytopathology is proposed in developing (middle-income) countries where infrastructure exists with experience of screening. 44 Castanon et al 45 found that cytopathology at a cutoff for high-grade squamous intraepithelial lesions or worse had a sensitivity of 79% for cancer. Many HICs are moving to primary screening by HPV testing.…”

Section: Methodsmentioning

confidence: 99%

Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries

Yadav¹,

Cree

Field

et al. 2022

JCO Global Oncology

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PURPOSE The rising cancer burden in low- and middle-income countries (LMICs) stresses already weak health care systems and poses unique challenges. In resource-constrained LMICs and in circumstances where most patients must pay out of pocket for diagnostic tests, these may not be available or affordable for many. Cytopathology provides a simple, inexpensive, standardized, and low-technology diagnostic procedure that is increasingly used as an effective tool to address the hurdles faced in cancer control programs in LMICs. This review explores the potential role of cytopathology in LMICs in reducing the cancer burden. METHODS This review studied the existing literature across the globe regarding the utilization of cytopathology as a diagnostic or screening tool for various types of malignancies as well as its advantages and disadvantages, depending on the local situation. RESULTS Apart from the usefulness of cytopathology, this review also sheds light on the barriers to using cytopathology in LMICs. Most recently, SARS-CoV-2 has produced several unique challenges for cytopathology. These are being met with innovative measures to combat the effects of the pandemic and ensure the safe delivery of essential cytopathology services. CONCLUSION The usefulness of cytopathologic techniques has been demonstrated via various studies, even during the recent pandemic. If cytology is to be used appropriately, the focus needs to be on integrating it into the national cancer screening and diagnostic programs as well as providing well-trained human resources.

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“…However, this review did not show results for other parameters, such as specificity, diagnostic OR, AUC on SROC. The estimated values of overall abnormal cytology and LSIL were not found in the previous review 40…”

Section: Discussionmentioning

confidence: 60%

“…In summary, the superiority of the HPV test for accurately diagnosing SIL or SqCC in the uterine cervix cannot be proven in the previous DTA review. In addition, in other DTA review,40 the pooled sensitivity of cytology with HSIL or worse was 79.4% for predicting cancer. However, this review did not show results for other parameters, such as specificity, diagnostic OR, AUC on SROC.…”

Section: Discussionmentioning

confidence: 86%

Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix

et al. 2019

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BackgroundEven though cervico-vaginal smears have been used as a primary screening test for cervical carcinoma, the diagnostic accuracy has been controversial. The present study aimed to evaluate the diagnostic accuracy of cytology for squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SqCC) of the uterine cervix through a diagnostic test accuracy (DTA) review.MethodsA DTA review was performed using 38 eligible studies that showed concordance between cytology and histology. In the DTA review, sensitivity, specificity, diagnostic odds ratio (OR), and the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated.ResultsIn the comparison between abnormal cytology and histology, the pooled sensitivity and specificity were 93.9% (95% confidence interval [CI], 93.7%–94.1%) and 77.6% (95% CI, 77.4–77.8%), respectively. The diagnostic OR and AUC on the SROC curve were 8.90 (95% CI, 5.57–14.23) and 0.8148, respectively. High-grade squamous intraepithelial lesion (HSIL) cytology had a higher sensitivity (97.6%; 95% CI, 94.7%–97.8%) for predicting HSIL or worse histology. In the comparison between SqCC identified on cytology and on histological analysis, the pooled sensitivity and specificity, diagnostic OR, and AUC were 92.7% (95% CI, 87.3%–96.3%), 87.5% (95% CI, 87.2%–87.8%), 865.81 (95% CI, 68.61–10,925.12), and 0.9855, respectively. Geographic locations with well-organized screening programs had higher sensitivity than areas with insufficient screening programs.ConclusionThese results indicate that cytology had a higher sensitivity and specificity for detecting SIL and SqCC of the uterine cervix during primary screening.

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Systematic Review and Meta-Analysis of Individual Patient Data to Assess the Sensitivity of Cervical Cytology for Diagnosis of Cervical Cancer in Low- and Middle-Income Countries

Cited by 6 publications

References 26 publications

Long term results of follow-up after HPV self-sampling with devices Qvintip and HerSwab in women non-attending cervical screening programme

Long term results of follow-up after HPV self-sampling with devices Qvintip and HerSwab in women non-attending cervical screening programme

Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries

Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix

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