J Korean Med Sci.  2019 Jan;34(2):e16. 10.3346/jkms.2019.34.e16.

Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix

• Pyo JS
• Kang G
• Yoon HK
• Kim HJ

• KMID: 2440162
• DOI: http://doi.org/10.3346/jkms.2019.34.e16

Abstract

BACKGROUND
Even though cervico-vaginal smears have been used as a primary screening test for cervical carcinoma, the diagnostic accuracy has been controversial. The present study aimed to evaluate the diagnostic accuracy of cytology for squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SqCC) of the uterine cervix through a diagnostic test accuracy (DTA) review.
METHODS
A DTA review was performed using 38 eligible studies that showed concordance between cytology and histology. In the DTA review, sensitivity, specificity, diagnostic odds ratio (OR), and the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated.
RESULTS
In the comparison between abnormal cytology and histology, the pooled sensitivity and specificity were 93.9% (95% confidence interval [CI], 93.7%-94.1%) and 77.6% (95% CI, 77.4-77.8%), respectively. The diagnostic OR and AUC on the SROC curve were 8.90 (95% CI, 5.57-14.23) and 0.8148, respectively. High-grade squamous intraepithelial lesion (HSIL) cytology had a higher sensitivity (97.6%; 95% CI, 94.7%-97.8%) for predicting HSIL or worse histology. In the comparison between SqCC identified on cytology and on histological analysis, the pooled sensitivity and specificity, diagnostic OR, and AUC were 92.7% (95% CI, 87.3%-96.3%), 87.5% (95% CI, 87.2%-87.8%), 865.81 (95% CI, 68.61-10,925.12), and 0.9855, respectively. Geographic locations with well-organized screening programs had higher sensitivity than areas with insufficient screening programs.
CONCLUSION
These results indicate that cytology had a higher sensitivity and specificity for detecting SIL and SqCC of the uterine cervix during primary screening.

Keyword

Cytology; Diagnostic Test Accuracy Review; Squamous Intraepithelial Lesion; Squamous Cell Carcinoma; Uterine Cervix

MeSH Terms

Area Under Curve
Carcinoma, Squamous Cell*
Cervix Uteri*
Diagnostic Tests, Routine*
Epithelial Cells*
Female
Geographic Locations
Mass Screening
Odds Ratio
ROC Curve
Sensitivity and Specificity
Squamous Intraepithelial Lesions of the Cervix*