scholarly journals Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

BMJ ◽  
2018 ◽  
pp. k499 ◽  
Author(s):  
Karoliina Tainio ◽  
Antonios Athanasiou ◽  
Kari A O Tikkinen ◽  
Riikka Aaltonen ◽  
Jovita Cárdenas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Active Surveillance ◽  
Clinical Course ◽  
Meta Analysis ◽  
Intraepithelial Neoplasia ◽  
Cervical Intraepithelial Neoplasia Grade

scholarly journals Accuracy of Smartphone Images of the Cervix After Acetic Acid Application for Diagnosing Cervical Intraepithelial Neoplasia Grade 2 or Greater in Women With Positive Cervical Screening: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1711-1721
Author(s):  
Emma R. Allanson ◽  
Natacha Phoolcharoen ◽  
Mila P. Salcedo ◽  
Bryan Fellman ◽  
Kathleen M. Schmeler
Keyword(s):  
Systematic Review ◽  
Acetic Acid ◽  
Positive Predictive Value ◽  
Cervical Intraepithelial Neoplasia ◽  
Predictive Value ◽  
Precancerous Lesions ◽  
Meta Analysis ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Cervical Intraepithelial Neoplasia Grade

PURPOSE Smartphones are used in cervical screening for visual inspection after acetic acid or Lugol's iodine (VIA/VILI) application to capture and share images to improve the sensitivity and interobserver variability of VIA/VILI. We undertook a systematic review and meta-analysis assessing the diagnostic accuracy of smartphone images of the cervix at the time of VIA/VILI (termed S-VIA) in the detection of precancerous lesions in women undergoing cervical screening. METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies from January 1, 2010, to June 30, 2020, were assessed. MEDLINE/PubMed, Embase, CINAHL, Cochrane, and LILACS were searched. Cohort and cross-sectional studies were considered. S-VIA was compared with the reference standard of histopathology. We excluded studies where additional technology was added to the smartphone including artificial intelligence, enhanced visual assessment, and other algorithms to automatically diagnose precancerous lesions. The primary outcome was the accuracy of S-VIA for the diagnosis of cervical intraepithelial neoplasia grade 2 or greater (CIN 2+). Data were extracted, and we plotted the sensitivity, specificity, negative predictive value, and positive predictive value of S-VIA using forest plots. This study was prospectively registered with The International Prospective Register of Systematic Reviews:CRD42020204024. RESULTS Six thousand three studies were screened, 71 full texts assessed, and eight studies met criteria for inclusion, with six included in the final meta-analysis. The sensitivity of S-VIA for the diagnosis of CIN 2+ was 74.56% (95% CI, 70.16 to 78.95; I2 61.30%), specificity was 61.75% (95% CI, 56.35 to 67.15; I2 95.00%), negative predictive value was 93.71% (95% CI, 92.81 to 94.61; I2 0%), and positive predictive value was 26.97% (95% CI, 24.13 to 29.81; I2 61.3%). CONCLUSION Our results suggest that S-VIA has accuracy in the detection of CIN 2+ and may provide additional support to health care providers delivering care in low-resource settings.

scholarly journals Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE Group

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028008 ◽  
Author(s):  
Antonios Athanasiou ◽  
Areti Angeliki Veroniki ◽  
Orestis Efthimiou ◽  
Ilkka Kalliala ◽  
Huseyin Naci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Local Treatment ◽  
Intraepithelial Neoplasia ◽  
Risk Of Bias ◽  
Analysis Tool ◽  
Complication Rates ◽  
Meta Analyses

IntroductionLocal treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications.Methods and analysisLiterature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool.Ethics and disseminationEthical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public.PROSPERO registration numberCRD42018115508.

scholarly journals Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis

BMJ ◽  
2014 ◽  
Vol 349 (oct28 1) ◽  
pp. g6192-g6192 ◽  
Author(s):  
M. Kyrgiou ◽  
A. Mitra ◽  
M. Arbyn ◽  
S. M. Stasinou ◽  
P. Martin-Hirsch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Intraepithelial Neoplasia ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Intraepithelial Neoplasia

scholarly journals Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Teruhiko Terasawa ◽  
Satoyo Hosono ◽  
Seiju Sasaki ◽  
Keika Hoshi ◽  
Yuri Hamashima ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Intraepithelial Neoplasia ◽  
Test Accuracy ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Validity Assessment ◽  
Screening Strategies ◽  
Comparative Accuracy ◽  
Paired Design ◽  
Asymptomatic Women

AbstractTo compare all available accuracy data on screening strategies for identifying cervical intraepithelial neoplasia grade ≥ 2 in healthy asymptomatic women, we performed a systematic review and network meta-analysis. MEDLINE and EMBASE were searched up to October 2020 for paired-design studies of cytology and testing for high-risk genotypes of human papillomavirus (hrHPV). The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, random-effects network meta-analysis of test accuracy, and GRADE rating. Twenty-seven prospective studies (185,269 subjects) were included. The combination of cytology (atypical squamous cells of undetermined significance or higher grades) and hrHPV testing (excepting genotyping for HPV 16 or 18 [HPV16/18]) with the either-positive criterion (OR rule) was the most sensitive/least specific, whereas the same combination with the both-positive criterion (AND rule) was the most specific/least sensitive. Compared with standalone cytology, non-HPV16/18 hrHPV assays were more sensitive/less specific. Two algorithms proposed for primary cytological testing or primary hrHPV testing were ranked in the middle as more sensitive/less specific than standalone cytology and the AND rule combinations but more specific/less sensitive than standalone hrHPV testing and the OR rule combination. Further research is needed to assess these results in population-relevant outcomes at the program level.

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