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
Objective: Portable devices that can be used to perform colposcopy may improve cervical cancer screening in low- and middle- income countries (LMIC) where access to colposcopy is limited. The objective of this study was to systematically review the diagnostic test accuracy (DTA) of these devices for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+).
Methods: In accordance with our protocol (Prospero CRD42018104286), we searched Embase, Medline and the Cochrane Controlled Register of Trials up to 9/2019. We included DTA studies, which investigated portable devices with moderate-to-high optical magnification (≥6x) for colposcopy, as described in the manual for Colposcopy and Treatment by the International Agency for Research on Cancer, with a histopathological reference standard. We used the QUADAS-2 tool to assess study quality. We examined results for sensitivity and specificity in paired forest plots, stratified by stages in the clinical pathway. We pooled estimates of test accuracy for the index test, used as an add-on to other tests, using a bivariate random-effect model.
Results: We screened 1737 references and assessed 239 full-text articles for eligibility. Five single-gate DTA studies, including 2693 women, met the inclusion criteria. Studies evaluated two devices (GynocularTM and Pocket) at different stages of the screening pathway. In three studies, which used the index test in an add-on capacity in 1273 women, we found a pooled sensitivity of 0.79 (95% CI: 0.55-0.92) and specificity of 0.83 (95% CI: 0.59-0.94). The main sources of bias were partial verification, incorporation and classification bias.
Conclusion: Few studies have evaluated portable devices able to perform colposcopy, so their accuracy for the detection of CIN2+ remains uncertain. Future studies should include patient-relevant and long-term outcomes, including missed cases, overtreatment, residual and recurrent disease. To meet the challenge of eliminating cervical cancer in LMIC, methods for visual assessment of the cervix need urgent redress.
Registration: Prospero, International prospective register of systematic reviews (CRD42018104286). Date of registration 27, July, 2018.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
On 16 Nov, 2020
On 16 Nov, 2020
On 04 Nov, 2020
Received 02 Nov, 2020
Received 31 Oct, 2020
On 29 Oct, 2020
On 26 Oct, 2020
On 22 Oct, 2020
Invitations sent on 22 Oct, 2020
On 21 Oct, 2020
On 21 Oct, 2020
Posted 06 Aug, 2020
On 19 Sep, 2020
Received 08 Sep, 2020
Received 07 Sep, 2020
Received 21 Aug, 2020
On 19 Aug, 2020
On 12 Aug, 2020
On 08 Aug, 2020
On 07 Aug, 2020
Invitations sent on 07 Aug, 2020
On 07 Aug, 2020
On 05 Aug, 2020
On 04 Aug, 2020
On 16 Jul, 2020
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
On 16 Nov, 2020
On 16 Nov, 2020
On 04 Nov, 2020
Received 02 Nov, 2020
Received 31 Oct, 2020
On 29 Oct, 2020
On 26 Oct, 2020
On 22 Oct, 2020
Invitations sent on 22 Oct, 2020
On 21 Oct, 2020
On 21 Oct, 2020
Posted 06 Aug, 2020
On 19 Sep, 2020
Received 08 Sep, 2020
Received 07 Sep, 2020
Received 21 Aug, 2020
On 19 Aug, 2020
On 12 Aug, 2020
On 08 Aug, 2020
On 07 Aug, 2020
Invitations sent on 07 Aug, 2020
On 07 Aug, 2020
On 05 Aug, 2020
On 04 Aug, 2020
On 16 Jul, 2020
Objective: Portable devices that can be used to perform colposcopy may improve cervical cancer screening in low- and middle- income countries (LMIC) where access to colposcopy is limited. The objective of this study was to systematically review the diagnostic test accuracy (DTA) of these devices for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+).
Methods: In accordance with our protocol (Prospero CRD42018104286), we searched Embase, Medline and the Cochrane Controlled Register of Trials up to 9/2019. We included DTA studies, which investigated portable devices with moderate-to-high optical magnification (≥6x) for colposcopy, as described in the manual for Colposcopy and Treatment by the International Agency for Research on Cancer, with a histopathological reference standard. We used the QUADAS-2 tool to assess study quality. We examined results for sensitivity and specificity in paired forest plots, stratified by stages in the clinical pathway. We pooled estimates of test accuracy for the index test, used as an add-on to other tests, using a bivariate random-effect model.
Results: We screened 1737 references and assessed 239 full-text articles for eligibility. Five single-gate DTA studies, including 2693 women, met the inclusion criteria. Studies evaluated two devices (GynocularTM and Pocket) at different stages of the screening pathway. In three studies, which used the index test in an add-on capacity in 1273 women, we found a pooled sensitivity of 0.79 (95% CI: 0.55-0.92) and specificity of 0.83 (95% CI: 0.59-0.94). The main sources of bias were partial verification, incorporation and classification bias.
Conclusion: Few studies have evaluated portable devices able to perform colposcopy, so their accuracy for the detection of CIN2+ remains uncertain. Future studies should include patient-relevant and long-term outcomes, including missed cases, overtreatment, residual and recurrent disease. To meet the challenge of eliminating cervical cancer in LMIC, methods for visual assessment of the cervix need urgent redress.
Registration: Prospero, International prospective register of systematic reviews (CRD42018104286). Date of registration 27, July, 2018.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5