Comparison of the Diagnostic Accuracy Between Two Diagnostic Methods in Patients with Cervical Intraepithelial Neoplasia_Chinese Journal of Evidence-Based Medicine

Authors：

REN Chang ¹ , PENG Zhilan ¹ , XU Liangzhi ¹² , WU Taixiang ² , LIU Guanjian ² , YANG Kaixuan ³

1. Department of Obstetrics and Gynecology; West China Second University Hospital; Sichuan University; Chengdu 610041; China2. Chinese Evidence-Based Medicine Centre/Clinical Epidemiology Resource and Training Centre （Chengdu）; West China Hospital; Sichuan University; Chengdu 610041; China3. Pathology Department; West China Second University Hospital; Sichuan University; Chengdu 610041; China;

Corresponding?author：

Keywords：

Colposcopically; Biopsy; Colposcopically directed biopsy; Conization/Cone biopsy; Diagnosis; Accuracy; Systematic review

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Objective 　To compare and evaluate the sensitivity, specificity, accuracy, negative and positive predictive values, negative and positive likelihood ratios of colposcopically directed biopsy and diagnostic cone biopsy in patients with cervical intraepithelial neoplasia.
Methods 　We searched PubMed, CBMdisc, CMCC, CNKI, and VIP to March 2004, and Cochrane Library (Issue 4, 2003). Related journals published from 1970 to 2003 and unpublished papers were hansearched. Diagnostic studies which employed colposcopically directed biopsy or diagnostic cone biopsy and compared with golden standard (pathological diagnosis of specimens obtained through therapeutic conization or hysterectomy) were included and meta-analysis was performed. Participants were clinically suspected of pre-cancerous cervical lesions. Quality of studies was assessed, and SROC curve by Diagnostic and Screening Group of the Cochrane Collaboration was used to perform meta-analysis. Parameters were sensitivity, specificity, accuracy, predictive values, and likelihood ratio.
Results 　Twenty six studies (3 376 patients ranging from 2 to 604 patients/per study) met the inclusion criteria. The quality of studies was generally poor.Before sensitivity analysis, superiority of diagnostic cone biopsy (sensitivity and specificity: 0.83) was shown over colposcopically directed biopsy (sensitivity and specificity: 0.76) (P＜0.001); while after sensitivity analysis the results reversed (sensitivity of diagnostic cone biopsy was 0.58 and its specificity was 0.61; sensitivity and specificity of colposcopically directed biopsy increased to 0.84) (P lt;0.001).
Conclusions 　No definite conclusioncan be drawn as to which method is superior. To make further analysis, more studies with high quality are needed.

Citation： REN Chang,PENG Zhilan,XU Liangzhi,WU Taixiang,LIU Guanjian,YANG Kaixuan. Comparison of the Diagnostic Accuracy Between Two Diagnostic Methods in Patients with Cervical Intraepithelial Neoplasia. Chinese Journal of Evidence-Based Medicine, 2004, 04(9): 595-601. doi: Copy

1.	［1］Wu TX, Liu GJ. What is the Bayes Library and how to do a systematic review of diagnostic test[J]. Chin J Evidence-Based Medicine, 2002; 2(3): 182-186.
2.	吳泰相, 劉關鍵. Bayes library簡介與診斷試驗系統評價方法[J]. 中國循證醫學雜志, 2002; 2(3):182～186.
3.	［2］Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of meta-analysis[J]. Chinese J Evidence-Based Medicine, 2003; 3(1): 41-44.
4.	劉關鍵, 吳泰相. 診斷性試驗的Meta分析-SROC曲線法介紹[J]. 中國循證醫學雜志, 2003; 3(1):41～44.
5.	［3］Diakomanolis E, Chatzipapas I, Haidopoulos D, Rodolakis A. Negative cone biopsies:A reappraisal[J]. J Reprod Med, D2003; 48(8): 617-621.
6.	［4］Shingleton HM, Gore H, Austin. JM Jr. Outpatient evaluation of patients with atypical papanicolaou smears: contribution of endocervical curettage[J]. Am J Obstet Gynecol, 1976; 126(1): 122-128.
7.	［5］Thomas C, Wright Jr, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer[J]. JAMA Chinese Edition, 2000; 19(5): 230-232 Thomas C, Wright Jr, Denny L, Kuhn L, Pollack A, Lorincz A.
8.	自我采集陰道標本HPV DNA檢測與細胞學普查檢出宮頸癌的比較[J]. 美國醫學會雜志中文版, 2000; 19(5): 230～232.
9.	［6］Ortiz R, Newton M, Langlois PL. Colposcopic biopsy in the diagnosis of carcinoma of the cervix[J]. Obstet Gynecol, 1969; 34(3): 303-306.
10.	［7］Gaglar H, Delgado G. Colposcopically directed cone biopsies in the management of cervical intraepithelial[J]. Neoplasia Obstet Gynecol, 1978; 51(5): 634-635.
11.	［8］Hoffman MS, Collins E, Roberts WS, Fiorica JV, Gunasekaran S, Cavanagh D. Cervical conization with frozen section before planned hysterectomy[J]. Obstet Gynecol, 1993; 82(3): 394-398.
12.	［9］Lou HK. Punch biopsy and cone biopsy in the diagnosis of early stage cervical cancer[J]. The Practical Journal of Cancer, 1994; 9(2): 119-120.
13.	樓洪坤. 點式活檢和錐切診斷早期宮頸癌[J]. 實用癌癥雜志, 1994; 9(2): 119～120.
14.	［10］Chen L, Gao YL. Cervical loop biopsy in diagnosis and treatment of cervical intraepithelial neoplasia and early stage cervical cancer[J]. Cancer Research and Clinic, 2003; 15(5): 325-326.
15.	陳魯, 高永良. 宮頸環切術診治宮頸上皮內瘤變和早期宮頸癌[J]. 腫瘤研究與臨床, 2003; 15(5): 325～326.
16.	［11］Bian ML, Liu XH, Sun AP, Leng B. Application of high frequency radiosurgical knife in the treatment of cervical disease[J]. Chin J Obstet Gynecol, 2000; 35(3): 160-162.
17.	卞美璐, 劉曉華, 孫藹萍, 冷冰. 高頻電波刀用于子宮頸病變診斷與治療的臨床觀察[J].中華婦產科雜志, 2000; 35(3): 160～162.
18.	［12］Ji H, Zheng XZ, Wang SS. Clinical Analysis of 56 Patients with Cervial Lesions Managed by Cervical Conization[J]. Central Plains Medical J, 2003; 30(12): 28.
19.	姬紅, 鄭秀芝, 王雙雙. 宮頸錐切治療宮頸病變56例臨床分析[J]. 中原醫刊, 2003; 30(12): 28.
20.	［13］Lu CZ, Cui SH, Ren LH. Preliminary Observation of Cervical Lesions Managed by LEEP[J]. Chinese Journal of Practical Gynecology and Obstetrics, 1999; 15(6): 347-349.
21.	盧翠貞, 崔淑惠, 任麗華. 環形電刀切除術治療宮頸病變的初步觀察[J]. 中國實用婦科與產科雜志, 1999; 15(6): 347～349.
22.	［14］Deng YQ, Xia EL, Meng G, Zhang HT. A new method of Cervical Lesion treatment without disturbing reproduction: Cervical Loop Excision[J].Chinese Journal of Family Planning, 2002; 10(11): 422-425.
23.	鄧元琪, 夏恩蘭, 孟戈, 張洪濤. 治療宮頸病變而不影響生殖的新方法:宮頸環形電切術[J]. 中國計劃生育學雜志, 2002; 10(11): 422～425.
24.	［15］Husseinzadeh N, Carter V, Wesseler T. Significance of positive endocervical curettage in predicting endocervical canal involvement in patients with cervical intraepithelial neoplasia[J]. Gynecol Oncol, 1989; 35(3): 358-361.
25.	［16］Buxton EJ, LuesleyDM, Shafi MI, Rollason M. Colposcopically directed punch biopsy: a potentially misleading investigation[J]. Br J Obstet Gynaecol, 1991; 98(12): 1 273-1 276.
26.	［17］Howe DT, Vincenti AC. Is large loop excision of the transformation zone(LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial Neoplasia[J]? Br J Obstet Gynaecol, 1991; 98(6): 588-591.
27.	［18］Bonardi R, Cecchini S, Grazzini G, Ciatto S. Loop electrosurgical excision procedure of the transformation zone and colposcopically directed punch biopsy in the diagnosis of cervical lesions[J]. Obstet Gynecol, 1992; 80(6): 1 020-1 022.
28.	［19］Wu YM, Deng XH. Value of cervical smear and colposcopic examination in the diagnosis of early Stage cervical cancer[J]. The Journal of Practical Medicine, 1997; 13(11): 737-738.
29.	吳玉梅, 鄧小虹. 宮頸細胞涂片及陰道鏡檢查診斷早期宮頸癌的價值[J]. 實用醫學雜志, 1997; 13(11): 737～738.
30.	［20］Li N, Zhang WH. Diagnosis and treatment of cervical intraepithelial neoplasia[J]. The Practical Journal of Cancer, 2001; 16(2): 140-143.
31.	李楠, 章文華. 宮頸上皮內瘤變150例臨床分析[J]. 實用癌癥雜志, 2001; 16(2): 140～143.
32.	［21］Stafl A, Mattingly RF. Colposcopic diagnosis of cervical neoplasia[J]. Obstet Gynecol, 1973; 41(2): 168-176.
33.	［22］Benedet JL, Boyes DA, Nichols TM, Millner A. Colposcopic evaluation of pregnant patients with abnormal cervical Smears[J]. Br J Obstet Gynaecol, 1977; 84(7): 517-521.
34.	［23］Veridiano NP, Delke I, Tancer M. Accuracy of colposcopically directed biopsy in patients with cervical neoplasia[J]. Obstet Gynecol, 1981; 58(2): 185-187.
35.	［24］Bertini-Oliveira AM, Keppler MM, Tarico S, Lopes VLD, Delascio D, Camano L. Comparative evaluation of abnormal cytology, colposcopy and histopathology in preclinical cervical malignancy during pregnancy[J]. Acta Cytologica, 1982; 26(5): 636-644.
36.	［25］Jafari K, Sansguiri R. Role of endocervical curettage in colposcopy[J]. Am J Obstet Gynecol, 1978; 131(1): 83-86.
37.	［26］Townsend DE, Ostergard DR, Mishell DR Jr, Hirose FM. Abnormal papanicolaou smears: evaluation by colposcopy, biopsies and endocervical curettage[J]. Am J Obstet Gynecol, 1970; 108(3): 429-434.
38.	［27］Jones HW III, Buller RE. The treatment of cervical intraepithelial neoplasia by cone biopsy[J]. Am J Obstet Gynecol, 1980; 137(8): 882-886.
39.	［28］Hellberg D, Nilsson S. 20-Year Experience of follow-up of the abnormal smear with colposcopy and histology and treatment by conization or cryosurgery[J]. Gynecol Oncol, 1990; 38(2): 166-169.
40.	［29］Albrechtsen R, Koch F. Prognostic accuracy of cervical cone biopsy[J]. Danish Medical Bulletin, 1972; 19(4): 119-121.

1. ［1］Wu TX, Liu GJ. What is the Bayes Library and how to do a systematic review of diagnostic test[J]. Chin J Evidence-Based Medicine, 2002; 2(3): 182-186.
2. 吳泰相, 劉關鍵. Bayes library簡介與診斷試驗系統評價方法[J]. 中國循證醫學雜志, 2002; 2(3):182～186.
3. ［2］Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of meta-analysis[J]. Chinese J Evidence-Based Medicine, 2003; 3(1): 41-44.
4. 劉關鍵, 吳泰相. 診斷性試驗的Meta分析-SROC曲線法介紹[J]. 中國循證醫學雜志, 2003; 3(1):41～44.
5. ［3］Diakomanolis E, Chatzipapas I, Haidopoulos D, Rodolakis A. Negative cone biopsies:A reappraisal[J]. J Reprod Med, D2003; 48(8): 617-621.
6. ［4］Shingleton HM, Gore H, Austin. JM Jr. Outpatient evaluation of patients with atypical papanicolaou smears: contribution of endocervical curettage[J]. Am J Obstet Gynecol, 1976; 126(1): 122-128.
7. ［5］Thomas C, Wright Jr, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer[J]. JAMA Chinese Edition, 2000; 19(5): 230-232 Thomas C, Wright Jr, Denny L, Kuhn L, Pollack A, Lorincz A.
8. 自我采集陰道標本HPV DNA檢測與細胞學普查檢出宮頸癌的比較[J]. 美國醫學會雜志中文版, 2000; 19(5): 230～232.
9. ［6］Ortiz R, Newton M, Langlois PL. Colposcopic biopsy in the diagnosis of carcinoma of the cervix[J]. Obstet Gynecol, 1969; 34(3): 303-306.
10. ［7］Gaglar H, Delgado G. Colposcopically directed cone biopsies in the management of cervical intraepithelial[J]. Neoplasia Obstet Gynecol, 1978; 51(5): 634-635.
11. ［8］Hoffman MS, Collins E, Roberts WS, Fiorica JV, Gunasekaran S, Cavanagh D. Cervical conization with frozen section before planned hysterectomy[J]. Obstet Gynecol, 1993; 82(3): 394-398.
12. ［9］Lou HK. Punch biopsy and cone biopsy in the diagnosis of early stage cervical cancer[J]. The Practical Journal of Cancer, 1994; 9(2): 119-120.
13. 樓洪坤. 點式活檢和錐切診斷早期宮頸癌[J]. 實用癌癥雜志, 1994; 9(2): 119～120.
14. ［10］Chen L, Gao YL. Cervical loop biopsy in diagnosis and treatment of cervical intraepithelial neoplasia and early stage cervical cancer[J]. Cancer Research and Clinic, 2003; 15(5): 325-326.
15. 陳魯, 高永良. 宮頸環切術診治宮頸上皮內瘤變和早期宮頸癌[J]. 腫瘤研究與臨床, 2003; 15(5): 325～326.
16. ［11］Bian ML, Liu XH, Sun AP, Leng B. Application of high frequency radiosurgical knife in the treatment of cervical disease[J]. Chin J Obstet Gynecol, 2000; 35(3): 160-162.
17. 卞美璐, 劉曉華, 孫藹萍, 冷冰. 高頻電波刀用于子宮頸病變診斷與治療的臨床觀察[J].中華婦產科雜志, 2000; 35(3): 160～162.
18. ［12］Ji H, Zheng XZ, Wang SS. Clinical Analysis of 56 Patients with Cervial Lesions Managed by Cervical Conization[J]. Central Plains Medical J, 2003; 30(12): 28.
19. 姬紅, 鄭秀芝, 王雙雙. 宮頸錐切治療宮頸病變56例臨床分析[J]. 中原醫刊, 2003; 30(12): 28.
20. ［13］Lu CZ, Cui SH, Ren LH. Preliminary Observation of Cervical Lesions Managed by LEEP[J]. Chinese Journal of Practical Gynecology and Obstetrics, 1999; 15(6): 347-349.
21. 盧翠貞, 崔淑惠, 任麗華. 環形電刀切除術治療宮頸病變的初步觀察[J]. 中國實用婦科與產科雜志, 1999; 15(6): 347～349.
22. ［14］Deng YQ, Xia EL, Meng G, Zhang HT. A new method of Cervical Lesion treatment without disturbing reproduction: Cervical Loop Excision[J].Chinese Journal of Family Planning, 2002; 10(11): 422-425.
23. 鄧元琪, 夏恩蘭, 孟戈, 張洪濤. 治療宮頸病變而不影響生殖的新方法:宮頸環形電切術[J]. 中國計劃生育學雜志, 2002; 10(11): 422～425.
24. ［15］Husseinzadeh N, Carter V, Wesseler T. Significance of positive endocervical curettage in predicting endocervical canal involvement in patients with cervical intraepithelial neoplasia[J]. Gynecol Oncol, 1989; 35(3): 358-361.
25. ［16］Buxton EJ, LuesleyDM, Shafi MI, Rollason M. Colposcopically directed punch biopsy: a potentially misleading investigation[J]. Br J Obstet Gynaecol, 1991; 98(12): 1 273-1 276.
26. ［17］Howe DT, Vincenti AC. Is large loop excision of the transformation zone(LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial Neoplasia[J]? Br J Obstet Gynaecol, 1991; 98(6): 588-591.
27. ［18］Bonardi R, Cecchini S, Grazzini G, Ciatto S. Loop electrosurgical excision procedure of the transformation zone and colposcopically directed punch biopsy in the diagnosis of cervical lesions[J]. Obstet Gynecol, 1992; 80(6): 1 020-1 022.
28. ［19］Wu YM, Deng XH. Value of cervical smear and colposcopic examination in the diagnosis of early Stage cervical cancer[J]. The Journal of Practical Medicine, 1997; 13(11): 737-738.
29. 吳玉梅, 鄧小虹. 宮頸細胞涂片及陰道鏡檢查診斷早期宮頸癌的價值[J]. 實用醫學雜志, 1997; 13(11): 737～738.
30. ［20］Li N, Zhang WH. Diagnosis and treatment of cervical intraepithelial neoplasia[J]. The Practical Journal of Cancer, 2001; 16(2): 140-143.
31. 李楠, 章文華. 宮頸上皮內瘤變150例臨床分析[J]. 實用癌癥雜志, 2001; 16(2): 140～143.
32. ［21］Stafl A, Mattingly RF. Colposcopic diagnosis of cervical neoplasia[J]. Obstet Gynecol, 1973; 41(2): 168-176.
33. ［22］Benedet JL, Boyes DA, Nichols TM, Millner A. Colposcopic evaluation of pregnant patients with abnormal cervical Smears[J]. Br J Obstet Gynaecol, 1977; 84(7): 517-521.
34. ［23］Veridiano NP, Delke I, Tancer M. Accuracy of colposcopically directed biopsy in patients with cervical neoplasia[J]. Obstet Gynecol, 1981; 58(2): 185-187.
35. ［24］Bertini-Oliveira AM, Keppler MM, Tarico S, Lopes VLD, Delascio D, Camano L. Comparative evaluation of abnormal cytology, colposcopy and histopathology in preclinical cervical malignancy during pregnancy[J]. Acta Cytologica, 1982; 26(5): 636-644.
36. ［25］Jafari K, Sansguiri R. Role of endocervical curettage in colposcopy[J]. Am J Obstet Gynecol, 1978; 131(1): 83-86.
37. ［26］Townsend DE, Ostergard DR, Mishell DR Jr, Hirose FM. Abnormal papanicolaou smears: evaluation by colposcopy, biopsies and endocervical curettage[J]. Am J Obstet Gynecol, 1970; 108(3): 429-434.
38. ［27］Jones HW III, Buller RE. The treatment of cervical intraepithelial neoplasia by cone biopsy[J]. Am J Obstet Gynecol, 1980; 137(8): 882-886.
39. ［28］Hellberg D, Nilsson S. 20-Year Experience of follow-up of the abnormal smear with colposcopy and histology and treatment by conization or cryosurgery[J]. Gynecol Oncol, 1990; 38(2): 166-169.
40. ［29］Albrechtsen R, Koch F. Prognostic accuracy of cervical cone biopsy[J]. Danish Medical Bulletin, 1972; 19(4): 119-121.

Chinese Journal of Evidence-Based Medicine

Comparison of the Diagnostic Accuracy Between Two Diagnostic Methods in Patients with Cervical Intraepithelial Neoplasia

Abstract Full text Figures/Tables Video References Cited by

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