WEPE087 - Poster Exhibition
Relative accuracy of cervical and anal cytology for detection of histopathologic high grade lesions by magnification guided biopsy: a cutpoint specific meta-analytic comparison
E. Cachay, W. Agmas, W. Mathews
University of California at San Diego, Medicine, San Diego, United States
Background: We recently reported, using a receiver operating characteristic (ROC) area metric, the first meta-analytic comparison of the relative accuracy of cervical and anal cytology in detecting moderate or severe (HSIL) histopathologic lesions by magnification directed punch biopsy (Mathews et al., PLoS One 2011, 6: e24946). The aim of the present research was to meta-analytically examine cutpoint specific operating characteristics (sensitivity [SE], specificity [SP]) of cervical and anal cytology in detecting HSIL histopathology by colposcopic and high resolution anoscopic (HRA) directed punch biopsy.
Methods: Eligible studies were identified by MEDLINE citation of relevant publications between 1990 and 2010. The primary eligibility requirement was availability of tabulated cytology (normal, ASCUS, LSIL, HSIL or ASC-H) and biopsy (< HSIL, ≥ HSIL) counts. Meta-analysis and meta-regression of diagnostic accuracy was performed using metandi and midas, respectively, implemented in Stata 11.2. QUADAS study quality criteria were rated and heterogeneity examined using I2statistic.
Results: 33 cervical and 11 anal publications were eligible. The Table presents the principal meta-analytic comparisons.
| ||Sensitivity (SE)||Specificity (SP)|
|Cytology Cut Point||Anal||Cervical||Anal||Cervical|
| ||SE||95% C.I.||SE||95% C.I.||SP||95% C.I.||SP||95% C.I.|
|(HSIL or ASC-H)vs.(LSIL,ASCUS,Normal)1||0.30||(0.19-0.44)||0.63||(0.56-0.69)||0.93||(0.90-0.95)||0.96||(0.95-0.98)|
|(HSIL or ASC-H,LSIL)vs.(ASCUS,Normal)2||0.73||(0.62-0.82)||0.80||(0.75-0.85)||0.55||(0.45-0.65)||0.76||(0.66-0.83)|
|(HSIL or ASC-H,LSIL,ASCUS)vs.(Normal)3||0.90||(0.76-0.96)||0.91||(0.88-0.94)||0.33||(0.20-0.49)||0.53||(0.40-0.66)|
1. Joint model comparison (cervical vs. anal): p< 0.001; I2=92; 2. Joint model comparison (cervical vs. anal): p< 0.001; I2=82; 3. Joint model comparison (cervical vs. anal): p=0.04; I2=68
The graphic shows ROC curve areas to compare the performance of anal and cervical cytology at different cut-points for identification of HSIL histological lesions.
Conclusions: Using a cytology cutpoint of HSIL or ASC-H, anal cytology is less sensitive but comparably specific compared to cervical cytology. However, using a cutpoint of ASCUS, differences in accuracy were of borderline significance. Study heterogeneity was large in both screening settings.
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