title: Accuracy of visual inspection with acetic acid and with Lugol's iodine for cervical cancer screening: Meta-analysis.
abstract: The aim of this review was to provide an updated summary estimation of the accuracy of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) in detecting cervical cancer and precancer. Studies on VIA/VILI accuracy were eligible in which VIA/VILI was performed on asymptomatic women who all underwent confirmatory testing of histology, combination of colposcopy and histology, or combination of multiple screening tests, colposcopy and histology, to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+ or CIN3+). A bivariate model was fitted to estimate the accuracy of VIA/VILI and provide estimates of heterogeneity. Subgroup analysis was used to investigate the source of heterogeneity. A total of 29 studies on VIA and 19 studies on VILI were included finally in the meta-analysis. The summary sensitivity and specificity of VIA for CIN2+ were 73.2% (95%CI: 66.5-80.0%) and 86.7% (95%CI: 82.9-90.4%), respectively, and those for VILI were 88.1% (95%CI: 81.5-94.7%) and 85.9% (95%CI: 81.7-90.0%), respectively. VIA and VILI were both more sensitive in detecting more severe outcome, although there was a slight loss in specificity. Apparent heterogeneity existed in sensitivity and specificity for both VIA and VILI. High sensitivity of both VIA and VILI for CIN2+ was found when a combination of colposcopy and histology was used as disease confirmation. VIA, VILI, even a combination of them in parallel, could be good options for cervical screening in low-resource settings. Significant differences in sensitivity between different gold standards might provide a proxy for optimization of ongoing cervical cancer screening programs.
authors.affiliation: Department of Cancer Prevention and Treatment, Sichuan Cancer Hospital and Institute and Sichuan Cancer Prevention and Treatment Center, Chengdu, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Qiao
authors.affiliation: Department of Cancer Prevention and Treatment, Sichuan Cancer Hospital and Institute and Sichuan Cancer Prevention and Treatment Center, Chengdu, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Cancer Prevention and Treatment, Sichuan Cancer Hospital and Institute and Sichuan Cancer Prevention and Treatment Center, Chengdu, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Long
authors.affiliation: Department of Cancer Prevention and Treatment, Sichuan Cancer Hospital and Institute and Sichuan Cancer Prevention and Treatment Center, Chengdu, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cancer Prevention and Treatment, Sichuan Cancer Hospital and Institute and Sichuan Cancer Prevention and Treatment Center, Chengdu, China.
authors.forename: Anrong
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Gynecologic Oncology, Sichuan Cancer Hospital and Institute and Sichuan Cancer Prevention and Treatment Center, Chengdu, China.
authors.forename: Guonan
authors.initials: G
authors.lastname: Zhang
mesh_terms: D019342:Acetic Acid; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007454:Iodides; D012680:Sensitivity and Specificity; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears
chemical_list: D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution
keywords: bivariate model; cervical cancer; meta-analysis; screening; visual inspection