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

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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 Related journals published from 1970 to 2003 and unpublished papers were hansearched.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.	吴泰相, 刘关键. Bayes library简介与诊断试验系统评价方法[J]. 中国循证医学杂志, 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.	刘关键, 吴泰相. 诊断性试验的Meta分析-SROC曲线法介绍[J]. 中国循证医学杂志, 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.	自我采集阴道标本HPV DNA检测与细胞学普查检出宫颈癌的比较[J]. 美国医学会杂志中文版, 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.	楼洪坤. 点式活检和锥切诊断早期宫颈癌[J]. 实用癌症杂志, 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.	陈鲁, 高永良. 宫颈环切术诊治宫颈上皮内瘤变和早期宫颈癌[J]. 肿瘤研究与临床, 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, 刘晓华, 孙蔼萍, 冷冰. 高频电波刀用于子宫颈病变诊断与治疗的临床观察[J].中华妇产科杂志, 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.	姬红, 郑秀芝, 王双双. 宫颈锥切治疗宫颈病变56例临床分析[J]. 中原医刊, 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.	卢翠贞, 崔淑惠, 任丽华. 环形电刀切除术治疗宫颈病变的初步观察[J]. 中国实用妇科与产科杂志, 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.	邓元琪, 夏恩兰, 孟戈, 张洪涛. 治疗宫颈病变而不影响生殖的新方法:宫颈环形电切术[J]. 中国计划生育学杂志, 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.	吴玉梅, 邓小虹. 宫颈细胞涂片及阴道镜检查诊断早期宫颈癌的价值[J]. 实用医学杂志, 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, 章文华. 宫颈上皮内瘤变150例临床分析[J]. 实用癌症杂志, 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. 吴泰相, 刘关键. Bayes library简介与诊断试验系统评价方法[J]. 中国循证医学杂志, 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. 刘关键, 吴泰相. 诊断性试验的Meta分析-SROC曲线法介绍[J]. 中国循证医学杂志, 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. 自我采集阴道标本HPV DNA检测与细胞学普查检出宫颈癌的比较[J]. 美国医学会杂志中文版, 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. 楼洪坤. 点式活检和锥切诊断早期宫颈癌[J]. 实用癌症杂志, 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. 陈鲁, 高永良. 宫颈环切术诊治宫颈上皮内瘤变和早期宫颈癌[J]. 肿瘤研究与临床, 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, 刘晓华, 孙蔼萍, 冷冰. 高频电波刀用于子宫颈病变诊断与治疗的临床观察[J].中华妇产科杂志, 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. 姬红, 郑秀芝, 王双双. 宫颈锥切治疗宫颈病变56例临床分析[J]. 中原医刊, 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. 卢翠贞, 崔淑惠, 任丽华. 环形电刀切除术治疗宫颈病变的初步观察[J]. 中国实用妇科与产科杂志, 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. 邓元琪, 夏恩兰, 孟戈, 张洪涛. 治疗宫颈病变而不影响生殖的新方法:宫颈环形电切术[J]. 中国计划生育学杂志, 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. 吴玉梅, 邓小虹. 宫颈细胞涂片及阴道镜检查诊断早期宫颈癌的价值[J]. 实用医学杂志, 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, 章文华. 宫颈上皮内瘤变150例临床分析[J]. 实用癌症杂志, 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

Format

Content