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Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies.

Fokom-Domgue J, Combescure C, Fokom-Defo V, Tebeu PM, Vassilakos P, Kengne AP, Petignat P - BMJ (2015)

Bottom Line: Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies.Pooled sensitivity and specificity were similar for HPV testing versus VIA (both P ≥ 0.23) and versus VILI (both P ≥ 0.16).Accuracy of VIA and VILI increased with sample size and time period.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1211 Geneva 14, Switzerland fokom.domgue@gmail.com.

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Fig 4 Positive and negative predictive values of VIA, VILI, and HPV testing in detecting CIN2+ in sub-Saharan Africa. Curves=variation of positive and negative predictive values as a function of the prevalence of disease (CIN2+) using the Bayes’theorem, by screening test and by geographical region (western Africa, middle Africa, southern Africa, and eastern Africa). We considered the absolute sensitivity and specificity of each test to be constant and equal to the pooled values calculated with a random effects model. Prevalence of CIN2+ is shown on the x axis, and the resulting positive or negative predictive values are noted on the y axis. Heavy dotted curves=​​fitted predictive values; light dotted curves=95% confidence bands; NPV=negative predictive value; PPV=positive predictive value
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fig4: Fig 4 Positive and negative predictive values of VIA, VILI, and HPV testing in detecting CIN2+ in sub-Saharan Africa. Curves=variation of positive and negative predictive values as a function of the prevalence of disease (CIN2+) using the Bayes’theorem, by screening test and by geographical region (western Africa, middle Africa, southern Africa, and eastern Africa). We considered the absolute sensitivity and specificity of each test to be constant and equal to the pooled values calculated with a random effects model. Prevalence of CIN2+ is shown on the x axis, and the resulting positive or negative predictive values are noted on the y axis. Heavy dotted curves=​​fitted predictive values; light dotted curves=95% confidence bands; NPV=negative predictive value; PPV=positive predictive value

Mentions: We could not perform pooled analysis of predictive values of screening tests, because they are closely related to the disease prevalence. However, we used the pooled prevalence of disease obtained among studies to estimate the post-test probability of having CIN2+ or being free of disease by geographical area (fig 4, web appendix 8). The pooled positive predictive value was lower than 35% for any screening tests wherever the geographical area, suggesting that combining tests might improve the effectiveness of screening programmes. In such situations, the second test can be either an adjunct to the first, or used to select women among those who screened positive to the first test and who are at higher risk for cervical cancer and might need immediate care. Although VILI has been proposed as an adjunctive test to VIA,13 results from primary studies are controversial. A study in Colombia found that the combination of VIA and VILI performed better than VIA alone,52 whereas a recent study in Kenya found no difference.53


Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies.

Fokom-Domgue J, Combescure C, Fokom-Defo V, Tebeu PM, Vassilakos P, Kengne AP, Petignat P - BMJ (2015)

Fig 4 Positive and negative predictive values of VIA, VILI, and HPV testing in detecting CIN2+ in sub-Saharan Africa. Curves=variation of positive and negative predictive values as a function of the prevalence of disease (CIN2+) using the Bayes’theorem, by screening test and by geographical region (western Africa, middle Africa, southern Africa, and eastern Africa). We considered the absolute sensitivity and specificity of each test to be constant and equal to the pooled values calculated with a random effects model. Prevalence of CIN2+ is shown on the x axis, and the resulting positive or negative predictive values are noted on the y axis. Heavy dotted curves=​​fitted predictive values; light dotted curves=95% confidence bands; NPV=negative predictive value; PPV=positive predictive value
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490835&req=5

fig4: Fig 4 Positive and negative predictive values of VIA, VILI, and HPV testing in detecting CIN2+ in sub-Saharan Africa. Curves=variation of positive and negative predictive values as a function of the prevalence of disease (CIN2+) using the Bayes’theorem, by screening test and by geographical region (western Africa, middle Africa, southern Africa, and eastern Africa). We considered the absolute sensitivity and specificity of each test to be constant and equal to the pooled values calculated with a random effects model. Prevalence of CIN2+ is shown on the x axis, and the resulting positive or negative predictive values are noted on the y axis. Heavy dotted curves=​​fitted predictive values; light dotted curves=95% confidence bands; NPV=negative predictive value; PPV=positive predictive value
Mentions: We could not perform pooled analysis of predictive values of screening tests, because they are closely related to the disease prevalence. However, we used the pooled prevalence of disease obtained among studies to estimate the post-test probability of having CIN2+ or being free of disease by geographical area (fig 4, web appendix 8). The pooled positive predictive value was lower than 35% for any screening tests wherever the geographical area, suggesting that combining tests might improve the effectiveness of screening programmes. In such situations, the second test can be either an adjunct to the first, or used to select women among those who screened positive to the first test and who are at higher risk for cervical cancer and might need immediate care. Although VILI has been proposed as an adjunctive test to VIA,13 results from primary studies are controversial. A study in Colombia found that the combination of VIA and VILI performed better than VIA alone,52 whereas a recent study in Kenya found no difference.53

Bottom Line: Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies.Pooled sensitivity and specificity were similar for HPV testing versus VIA (both P ≥ 0.23) and versus VILI (both P ≥ 0.16).Accuracy of VIA and VILI increased with sample size and time period.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, 1211 Geneva 14, Switzerland fokom.domgue@gmail.com.

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Related in: MedlinePlus