Diagnostic Accuracy of Liquid-Based Cytology versus Conventional Cytology for Cervical Neoplasia: A Systematic Review of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

LI Kemin ¹ ,  YIN Rutie ¹ , KANG Deyin ² , WU Weiwei ³ , WEN Jin ²

1. Department of Gynecology of West China Second University Hospital of SiChuan University, Chengdu 610041, China;2. China Cochrane Center, SiChuan University, Chengdu 610041, China;3. Department of Pathology of West China Second University Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

YIN Rutie, Email: yinrutie2008@yahoo.cn

Keywords：

Cervical dysplasia; Liquid-based cytology; Conventional cytology; Cervical neoplasia; Systematic review

DOI：

10.7507/1672-2531.20110191

Video：

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Objective 　To evaluate the diagnostic accuracy of liquid-based cytology versus conventional cytology for cervical neoplasia.
Methods 　Such databases as PubMed, Embase, The Cochrane Library, Cochrane Central Register of Controlled Trials, CNKI and CBM were searched to collect the random control trials (RCTs) about evaluating the diagnostic accuracy of liquid-based cytology versus conventional cytology for cervical neoplasia published before June, 2010. According to the inclusive and exclusive criteria, two assessors independently screened the studies, extracted the data, assessed the quality and conducted meta-analysis by using RevMan 5.0 and Metadisc 1.4 softwares.
Results 　A total of five RCTS were eligible. With the ASCUS regarded as the abnormal critical value, there were significant differences between liquid-based cytology and conventional cytology in specificity for CIN 3+ (RR=0.97, 95%CI 0.97 to 0.97, P lt;0.000 01) and CIN 2+ of high risk population (RR=1.01, 95%CI 1.01 to 1.01, P lt;0.000 01), but no significant differences were found in other outcomes.
Conclusion 　Based on the current evidence of evidence-based medicine, the liquid-based cytology is of neither more specificity nor more sensitivity for detecting high grade CIN than the convention cytology in the regular screening program, but it seems to be of more specificity in high risk group.

Citation： LI Kemin,YIN Rutie,KANG Deyin,WU Weiwei,WEN Jin. Diagnostic Accuracy of Liquid-Based Cytology versus Conventional Cytology for Cervical Neoplasia: A Systematic Review of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2011, 11(10): 1133-1139. doi: 10.7507/1672-2531.20110191 Copy

1.	2 Hutchinson ML, Zahniser DJ, Sherman ME, et al . Utility of liquid-based cytology for cervical carcinoma screening: results of a population-based study conducted in a region of Costa Rica with a high incidence of cervical carcinoma. Cancer , 1999, 87(2): 48-55.
2.	Disaia PJ, Creasman WT. Clinical gynecologic oncology. 6th ed. Health Science Asia, Elsevier Science, 2002: 12-14.
3.	Monsonego J, Autillo-Touati A, Bergeron C, et al . Liquid-based cytology in the primary screening for cervical cancer: a multicenter study. Br J Cancer , 2001, 84(3): 360-366.
4.	Ferenczy A, Robitaille J, Franco E, et al . Conventional cervical cytologic smears vs. ThinPrep smears. A paired comparison study on cervical cytology. Acta Cytol , 1996, 40(6): 1136-1142.
5.	Bernstein SJ, Sanchez-Ramos L, Ndubisi B. Liquid-based cervical cytologic smear study and conventional papanicolaou smears：a metaanalysis of prospective studies comparing cytologic diagnosis and sample adequacy. Am J Obstet Gynecol , 2001, 185(2): 308-317.
6.	Arbyn M, Bergeron C, Klinkhamer P, et al . Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstatrics & Gynecology , 2008, 11(1): 167-177.
7.	Solomon D, Davey D, Kurman R, et al . The 2001 Bethesda System：terminology for reporting results of cervical cytology. JAMA , 2002, 287(16): 2114-2119.
8.	Richart RM. Cervical intraepithelial neoplasia. Pathol Annu , 1973, 8(62): 301-328.
9.	de Vet HCW, Eisinga A, Riphagen II, et al . Searching for studies//Deeks JJ,Bossuyt PM,Gatsonis C. Cochrane handbook for diagnostic test accuracy version 1.0.0. The Cochrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
10.	Smidt N, Deeks J, Moore T. Guide to the contents of a Cochrane review and protocol for Diagnostic Test Accuracy version 1.0.1 (updated February 2008). The Conchrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
11.	Whiting P, Rutjes AW, Reitsma JB, et al . The development of QUADAS：a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. B MC Med Res Methodol , 2003. Available from：URL：http://www.biomedcentral.com/1471-2288/3/25.
12.	Whiting PF, Weswood ME, Rutjes AW, et al . Evaluation of QUADAS，a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol , 2006. Available from: URL: http://www.biomedcentral.com/1471-2288/6/9.
13.	Cochran WG. The combination of estimates from different experiments. Biometrics , 1954, 10(6): 101-129.
14.	Higgins JP, Thompson SG, Deeks JJ, et al . Measuring inconsistency in meta-analyses. BMJ , 2003, 327(7414): 557-560.
15.	Taylor S, Kuhn L, Dupree W, et al . Direct comparison of liquid-based and conventional cytology in a South African screening trial. Int J Cancer , 2006, 118(4): 957-962.
16.	Ronco G, Cuzick J, Pierotti P, et al . Accuracy of liquid based versus conventional cytology：overall results of new technologies for cervical cancer screening randomised controlled trial. BMJ , 2007, 335(7609): 28.
17.	Maccallini V, Angeloni C, Caraceni D, et al . Comparison of the conventiontional cervical smear and liquid-based cytology: results of a controlled, prospective study in the Abruzzo region of Italy. Acta Cytol , 2008, 52(5): 568-574.
18.	Sykes PH, Harker DY, Miller A, et al . A randomised comparison of SurePath liquid-based cytology and conventional smear cytology in a colposcopy clinic setting. BJOG , 2008, 115(11): 1375-1381.
19.	Siebers AG, Klinkhamer PJ, Grefte JM, et al . Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA , 2009, 302(16): 1757-1764.
20.	Ronco G, Segnan N, Giorgi-Rossi P, et al . Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst , 2006, 98(11): 765-774.
21.	Ronco G, Giorgi-Rossi P, Carozzi F, et al . Human papillomavirus testing and liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomised controlled trial. Lancet Oncol , 2006, 7(7): 547-555.
22.	Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: Results of the recruitment phase of a large randomized controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
23.	Partridge EE, Abu-Rustum N, Campos SM, et al . Cervical cancer screening. V.1.2010. NCCN clinical practice guidelines in oncology. Available from: URL: http://www.nccn.org.
24.	邹维霞, 李国俊. 液基超薄涂片与传统宫颈涂片在筛查宫颈癌方面的研究. 中国妇幼保健, 2004, 19(15): 52-53.
25.	Strander B, Andersson-Ellström A, Milsom I, et al . Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program：a prospective randomized study. Cancer , 2007, 111(5): 285-291.

1. 2 Hutchinson ML, Zahniser DJ, Sherman ME, et al . Utility of liquid-based cytology for cervical carcinoma screening: results of a population-based study conducted in a region of Costa Rica with a high incidence of cervical carcinoma. Cancer , 1999, 87(2): 48-55.
2. Disaia PJ, Creasman WT. Clinical gynecologic oncology. 6th ed. Health Science Asia, Elsevier Science, 2002: 12-14.
3. Monsonego J, Autillo-Touati A, Bergeron C, et al . Liquid-based cytology in the primary screening for cervical cancer: a multicenter study. Br J Cancer , 2001, 84(3): 360-366.
4. Ferenczy A, Robitaille J, Franco E, et al . Conventional cervical cytologic smears vs. ThinPrep smears. A paired comparison study on cervical cytology. Acta Cytol , 1996, 40(6): 1136-1142.
5. Bernstein SJ, Sanchez-Ramos L, Ndubisi B. Liquid-based cervical cytologic smear study and conventional papanicolaou smears：a metaanalysis of prospective studies comparing cytologic diagnosis and sample adequacy. Am J Obstet Gynecol , 2001, 185(2): 308-317.
6. Arbyn M, Bergeron C, Klinkhamer P, et al . Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstatrics & Gynecology , 2008, 11(1): 167-177.
7. Solomon D, Davey D, Kurman R, et al . The 2001 Bethesda System：terminology for reporting results of cervical cytology. JAMA , 2002, 287(16): 2114-2119.
8. Richart RM. Cervical intraepithelial neoplasia. Pathol Annu , 1973, 8(62): 301-328.
9. de Vet HCW, Eisinga A, Riphagen II, et al . Searching for studies//Deeks JJ,Bossuyt PM,Gatsonis C. Cochrane handbook for diagnostic test accuracy version 1.0.0. The Cochrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
10. Smidt N, Deeks J, Moore T. Guide to the contents of a Cochrane review and protocol for Diagnostic Test Accuracy version 1.0.1 (updated February 2008). The Conchrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
11. Whiting P, Rutjes AW, Reitsma JB, et al . The development of QUADAS：a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. B MC Med Res Methodol , 2003. Available from：URL：http://www.biomedcentral.com/1471-2288/3/25.
12. Whiting PF, Weswood ME, Rutjes AW, et al . Evaluation of QUADAS，a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol , 2006. Available from: URL: http://www.biomedcentral.com/1471-2288/6/9.
13. Cochran WG. The combination of estimates from different experiments. Biometrics , 1954, 10(6): 101-129.
14. Higgins JP, Thompson SG, Deeks JJ, et al . Measuring inconsistency in meta-analyses. BMJ , 2003, 327(7414): 557-560.
15. Taylor S, Kuhn L, Dupree W, et al . Direct comparison of liquid-based and conventional cytology in a South African screening trial. Int J Cancer , 2006, 118(4): 957-962.
16. Ronco G, Cuzick J, Pierotti P, et al . Accuracy of liquid based versus conventional cytology：overall results of new technologies for cervical cancer screening randomised controlled trial. BMJ , 2007, 335(7609): 28.
17. Maccallini V, Angeloni C, Caraceni D, et al . Comparison of the conventiontional cervical smear and liquid-based cytology: results of a controlled, prospective study in the Abruzzo region of Italy. Acta Cytol , 2008, 52(5): 568-574.
18. Sykes PH, Harker DY, Miller A, et al . A randomised comparison of SurePath liquid-based cytology and conventional smear cytology in a colposcopy clinic setting. BJOG , 2008, 115(11): 1375-1381.
19. Siebers AG, Klinkhamer PJ, Grefte JM, et al . Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA , 2009, 302(16): 1757-1764.
20. Ronco G, Segnan N, Giorgi-Rossi P, et al . Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst , 2006, 98(11): 765-774.
21. Ronco G, Giorgi-Rossi P, Carozzi F, et al . Human papillomavirus testing and liquid-based cytology in primary screening of women younger than 35 years: results at recruitment for a randomised controlled trial. Lancet Oncol , 2006, 7(7): 547-555.
22. Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: Results of the recruitment phase of a large randomized controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
23. Partridge EE, Abu-Rustum N, Campos SM, et al . Cervical cancer screening. V.1.2010. NCCN clinical practice guidelines in oncology. Available from: URL: http://www.nccn.org.
24. 邹维霞, 李国俊. 液基超薄涂片与传统宫颈涂片在筛查宫颈癌方面的研究. 中国妇幼保健, 2004, 19(15): 52-53.
25. Strander B, Andersson-Ellström A, Milsom I, et al . Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program：a prospective randomized study. Cancer , 2007, 111(5): 285-291.

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Diagnostic Accuracy of Liquid-Based Cytology versus Conventional Cytology for Cervical Neoplasia: A Systematic Review of Randomized Controlled Trials

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