title: Systematic reviews and meta-analyses of the accuracy of HPV tests, visual inspection with acetic acid, cytology, and colposcopy.
abstract: BACKGROUND
  Cervical cancer screening is offered to women to identify and treat cervical intraepithelial neoplasia (CIN).
  
  
  OBJECTIVE
  To support WHO guidelines, a systematic review was performed to compare test accuracy of the HPV test, cytology (cervical smear), and unaided visual inspection with acetic acid (VIA); and to determine test accuracy of HPV and colposcopy impression.
  
  
  METHODS
  Medline and Embase were searched up to September 2012, and experts were contacted for references.
  
  
  METHODS
  Studies of at least 100 nonpregnant women (aged ≥18years) not previously diagnosed with CIN were included.
  
  
  METHODS
  Two investigators independently screened and collected data. Pooled sensitivity and specificity, and absolute differences were calculated, and the quality of evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
  
  
  RESULTS
  High to moderate quality evidence was found. The greatest difference in overtreatment occurred with VIA instead of the cervical smear (58 more per 1000 women). Differences in missed treatment ranged from 2-5 per 1000 women. For 1000 women screened positive and then sent to colposcopy, 464 would be falsely diagnosed with CIN grade 2-3 and treated.
  
  
  CONCLUSIONS
  Although differences in sensitivity between tests could be interpreted as large, absolute differences in missed diagnoses were small. By contrast, small differences in specificity resulted in fairly large absolute differences in overtreatment.
authors: Departments of Internal Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Reem A
authors: RA
authors: Mustafa
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Nancy
authors: N
authors: Santesso
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors: Rasha
authors: R
authors: Khatib
authors: Faculty of Medicine, University of Science and Technology, Irbid, Jordan.
authors: Ahmad A
authors: AA
authors: Mustafa
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Wojtek
authors: W
authors: Wiercioch
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Rohan
authors: R
authors: Kehar
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Shreyas
authors: S
authors: Gandhi
authors: Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors: Yaolong
authors: Y
authors: Chen
authors: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors: Adrienne
authors: A
authors: Cheung
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Jessica
authors: J
authors: Hopkins
authors: Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
authors: Bin
authors: B
authors: Ma
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Nancy
authors: N
authors: Lloyd
authors: Department of Clinical Epidemiology, 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
authors: Darong
authors: D
authors: Wu
authors: Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors: Nathalie
authors: N
authors: Broutet
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: schuneh@mcmaster.ca.
authors: Holger J
authors: HJ
authors: Schünemann
mesh_terms: D019342:Acetic Acid; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D019342:Acetic Acid
keywords: Cervical intraepithelial neoplasia; Cervical smear; Colposcopy; Cytology; HPV; Meta-analysis; Review; Visual inspection with acetic acid