comparative accuracy of anal and cervical cytology in screening for moderate to severe dysplasia by magnification guided punch biopsy a meta-analysis比较准确的肛门和宫颈细胞学筛查中度到重度发育不良的放大引导打孔切片分析.pdfVIP

Comparative Accuracy of Anal and Cervical Cytology in Screening for Moderate to Severe Dysplasia by Magnification Guided Punch Biopsy: A Meta-Analysis Wm. Christopher Mathews*, Wollelaw Agmas, Edward Cachay Department of Medicine, University of California San Diego, San Diego, California, United States of America Abstract Background: The accuracy of screening for anal cancer precursors relative to screening for cervical cancer precursors has not been systematically examined. The aim of the current meta-analysis was to compare the relative accuracy of anal cytology to cervical cytology in discriminating between histopathologic high grade and lesser grades of dysplasia when the reference standard biopsy is obtained using colposcope magnification. Methods and Findings: The outcome metric of discrimination was the receiver operating characteristic (ROC) curve area. Random effects meta-analysis of eligible studies was performed with examination of sources of heterogeneity that included QUADAS criteria and selected covariates, in meta-regression models. Thirty three cervical and eleven anal screening studies were found to be eligible. The primary meta-analytic comparison suggested that anal cytologic screening is somewhat less discriminating than cervical cytologic screening (ROC area [95% confidence interval (C.I.)]: 0.834 [0.809–0.859] vs. 0.700 [0.664–0.735] for cervical and anal screening, respectively). This finding was robust when examined in meta-regression models of covariates differentially distributed by screening setting (anal, cervical). Conclusions: Anal cytologic screening is somewhat less discriminating than cervical cytologic screening. Heterogeneity of estimates within each screening setting suggests that other factors influence estimates of screening accuracy. Among these are sampling and interpretation errors involv