World Health Organization Guidelines: Use of cryotherapy for cervical intraepithelial neoplasia

Santesso, Nancy; Schünemann, Holger J.; Blumenthal, Paul D.; Vuyst, Hugo De; Gage, Julia C.; García, Francisco; Jerónimo, José; Lu, Ricky; Luciani, Silvana; Quek, Swee Chong; Awad, Tahany; Broutet, Nathalie

doi:10.1016/j.ijgo.2012.01.029

Cited by 46 publications

(29 citation statements)

References 3 publications

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“…The EtDs were developed based on GRADE evidence to decision tables first utilized in a WHO guideline on avian influenza [ 15 , 16 ]. The original evidence to decision table (rather than framework) only included five decision criteria [ 16 , 17 ]. Table 1 describes the iterative changes that were made to the EtD framework during this project.…”

Section: Methodsmentioning

confidence: 99%

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels

Neumann

Brignardello‐Petersen

Wiercioch

et al. 2015

Implementation Sci

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BackgroundJudgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers’ judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels.MethodsFollowing the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively.ResultsThe EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections (e.g., “values and preferences” and “balance between benefits and harms”) required further development and clarification that were considered in the current version of the EtD framework.ConclusionsThe use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0462-y) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels

Neumann

Brignardello‐Petersen

Wiercioch

et al. 2015

Implementation Sci

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“…loop electrosurgical excision procedure (LEEP), or cold knife conization (CKC) [3] , [6] – [15] . However, cryotherapy is more feasible and affordable than excisional treatment in low- and middle-income countries [16] . Little information is available on the efficacy of cryotherapy for the treatment of CIN2/3 in HIV-positive women [6] and none on the impact of cryotherapy on HPV persistence, i.e., a strong risk factor for residual/recurrent disease in HIV-negative women [4] , [5] .…”

Section: Introductionmentioning

confidence: 99%

Residual Disease and HPV Persistence after Cryotherapy for Cervical Intraepithelial Neoplasia Grade 2/3 in HIV-Positive Women in Kenya

et al. 2014

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ObjectiveTo assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.DesignFollow-up study.Methods79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).ResultsAt 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI): 66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at baseline. CD4 count and duration of combination antiretroviral therapy (cART) were not associated with residual CIN2/3. CIN3 instead of CIN2 was the only significant risk factor for residual disease (odds ratio, OR vs CIN2 = 4.3; 95% CI: 1.2–15.0) among hrHPV-positive women after adjustment for age and HPV16 infection. Persistence of hrHPV types previously detected in biopsies was found in 77.5% of women and was associated with residual CIN2/3 (OR = 8.1, 95% CI: 0.9–70). The sensitivity, specificity, and negative predictive value of hrHPV test in detecting residual CIN2/3 were 0.94, 0.36, and 0.96 respectively.ConclusionsNearly one quarter of HIV-positive women had residual CIN2/3 disease at 6 months after cryotherapy, and the majority had persistent hrHPV. CD4 count and cART use were not associated with residual disease or hrHPV persistence. The value of hrHPV testing in the detection of residual CIN2/3 was hampered by a low specificity.

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“…Cryotherapy services are more affordable and feasible, and require less capital investment and maintenance than excisional techniques; in addition, they can be easily established in low‐resource settings. Their effectiveness, safety, and acceptability, when performed by trained mid‐level providers as an outpatient procedure, have been demonstrated in different settings [5–9], and in more than 80% of women with high‐grade lesions involving the ectocervix, disease clearance has been achieved via a double‐freeze technique. Nevertheless, additional information from low‐resource setting is still warranted.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of cryotherapy for histologically confirmed cervical intraepithelial neoplasia grades 1 and 2 in an Indian setting

Wesley

Muwonge

Sauvaget

et al. 2013

Intl J Gynecology & Obste

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World Health Organization Guidelines: Use of cryotherapy for cervical intraepithelial neoplasia

Abstract: The present document summarizes new evidence-based WHO recommendations about the use of cryotherapy in women with histologically confirmed CIN for low-, middle-, and high-income countries.

Cited by 46 publications

References 3 publications

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels

Residual Disease and HPV Persistence after Cryotherapy for Cervical Intraepithelial Neoplasia Grade 2/3 in HIV-Positive Women in Kenya

Effectiveness of cryotherapy for histologically confirmed cervical intraepithelial neoplasia grades 1 and 2 in an Indian setting

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