Screening test accuracy of portable devices that can be used to perform colposcopy for detecting CIN2+ in low- and middle-income countries: a systematic review and meta-analysis

Taghavi, Katayoun; Rohner, Eliane; Basu, Partha; Low, Nicola; Rutjes, Anne W S; Bohlius, Julia

doi:10.1186/s12905-020-01121-3

Cited by 7 publications

(9 citation statements)

References 46 publications

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“…Again, these not-so-subtle differences appear to relate to a colposcopists’ skillsets or bias caused by assuming the biopsy is a form of colposcopic confirmation. The disagreement might be improved by advocating novel methods such as artificial intelligence used for grading colposcopic impressions and guiding biopsies [ 34 , 35 ], as well as portable devices that can be used to perform colposcopy [ 36 ]. Both have shown potential in improving the diagnostic quality of colposcopy.…”

Section: Discussionmentioning

confidence: 99%

Assessing colposcopic accuracy for high‐grade squamous intraepithelial lesion detection: a retrospective, cohort study

Bai

Wang

et al. 2022

BMC Women's Health

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Background Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors. Methods Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists’ competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard. Results Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma. Conclusion Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.

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Section: Discussionmentioning

confidence: 99%

Assessing colposcopic accuracy for high‐grade squamous intraepithelial lesion detection: a retrospective, cohort study

Bai

Wang

et al. 2022

BMC Women's Health

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“…Earlier studies that compared Gynocular and standard colposcopes had several limitations. In these studies, cervical biopsies were not performed in all women, resulting in partial verification bias [9]. In our study, this partial verification bias was eliminated by performing cervical biopsies on all women.…”

Section: Discussionmentioning

confidence: 89%

“…Informed consent was obtained from all participants, and the study was approved by the institutional ethics committee. Moreover, in our study, at least 2 cervical biopsies were performed in all women to minimize misclassification [4,9]. Another merit of our study was that the investigator was blinded to earlier colposcopic findings.…”

Section: Discussionmentioning

confidence: 99%

“…Very few studies have compared the diagnostic accuracy of a Gynocular colposcope with that of a standard colposcope [4,7,8]. A recent meta-analysis of portable colposcopes emphasized the need for more studies [9]. In this study, we aimed to compare the diagnostic accuracy of the Gynocular and standard colposcopes in detecting cervical intraepithelial neoplasia (CIN) 2+ (CIN 2, CIN 3, CIN 3+) lesions.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of hand-held colposcope (Gynocular) in comparison with standard colposcope in patients with abnormal cervical cytology or visual inspection with acetic acid positivity: a cross over randomized controlled study

Jayabalan¹,

Subbaiah²,

Chaturvedula³

2023

Obstet Gynecol Sci

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ObjectiveTo compare the diagnostic accuracy of a handheld colposcope (Gynocular) versus a standard colposcope in women with abnormal cervical cytology or visual Inspection with acetic acid positivity.MethodsThis crossover randomized clinical trial was conducted in Pondicherry, India, and included 230 women who were referred for colposcopy. Swede scores were calculated using both colposcopes, and a cervical biopsy was performed from the most visually abnormal areas. Swede scores were compared with the histopathological diagnosis, which was used as the reference standard. The level of agreement between the two colposcopes was calculated using Kappa (κ) statistics.ResultsThe level of agreement of Swede scores between the standard and Gynocular colposcopes was 62.56%, and the κ statistic was 0.43 (P<0.001). Cervical intraepithelial neoplasia (CIN) 2+ (CIN 2, CIN 3, CIN 3+) was diagnosed in 40 (17.4%) women. There were no significant differences between the two colposcopes in terms of sensitivity, specificity, or predictive value for detecting CIN 2+ lesions.ConclusionThe diagnostic accuracy of Gynocular colposcopy was similar to that of standard colposcopy for detecting CIN 2+ lesions. Gynocular colposcopes showed a good level of agreement with standard colposcopes when the Swede score was used.

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“…The use of mobile colposcopes has simplified cervical precancer screening. 27 , 28 There is evidence that some mobile colposcopes perform similarly to traditional stationary colposcopes. 29 , 30 Several studies have shown that there is no difference in performance between medical doctors and middle cadre staff like nurses in colposcopy 31 and that there is no difference in performance between doctors and nurses when using the mobile colposcope.…”

Section: Discussionmentioning

confidence: 99%

Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

Mensah

Badzi²,

Effah

et al. 2022

gmj

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Objectives: Cervical precancer screening programs are difficult to establish in low resource settings partly because of a lack of human resource. Our aiming was to overcome this challenge. We hypothesized that this could be done through task shifting to trained nurses.Design: Descriptive retrospective cross-sectional review.Setting: Training was at the Cervical Cancer Prevention and Training Center (CCPTC) and screening was carried out at the clinic and at outreaches / peripheral facilities.Participants: All women who reported to the clinic for screening or were recruited during outreachesInterventions: All 4 nurses were trained for at least 2weeks (module 1). A total of 904 women were screened by the trained nurses using the EVA system. Quality assurance was ensured.Main outcome measures: Primary screening and follow-up were carried out by the trained nurses with quality assured through image sharing and meetings with peers and experienced gynaecologists.Results: 828 women had primary screening and 76 had follow-up screening. 739 (89.3%) were screened at the clinic and 89 (10.7%) at outreaches/peripheral facilities. Of all screened, 130 (14.5%) had cervical lesions, and 25 (2.8%) were treated, 12 (48.0%) by Loop Electrosurgical Excision Procedure (LEEP) performed by a gynaecologist, 11 (44.0%) with thermal coagulation by trained nurses except one, and 2 (8.0%) with cryotherapy by trained nurses.Conclusion: We demonstrate the utility of a model where nurses trained in basic colposcopy can be used to success-fully implement a cervical precancer screening and treatment program in low-resource settings.

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Screening test accuracy of portable devices that can be used to perform colposcopy for detecting CIN2+ in low- and middle-income countries: a systematic review and meta-analysis

Cited by 7 publications

References 46 publications

Assessing colposcopic accuracy for high‐grade squamous intraepithelial lesion detection: a retrospective, cohort study

Assessing colposcopic accuracy for high‐grade squamous intraepithelial lesion detection: a retrospective, cohort study

Diagnostic accuracy of hand-held colposcope (Gynocular) in comparison with standard colposcope in patients with abnormal cervical cytology or visual inspection with acetic acid positivity: a cross over randomized controlled study

Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

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