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자궁경부암 선별검사의 진단정확도: 체계적 문헌고찰 및 메타분석

Diagnostic accuracy of cervical cancer screening methods in Korea: A Systemic review and meta-analysis

근거와 가치
2015년 1권 2호 p.89 ~ p.94
고민정 ( Ko Min-Jung ) - 한국보건의료연구원

심정임 ( Shim Jung-Im ) - 한국보건의료연구원
최성미 ( Choi Seong-Mi ) - 한국감정원 부동산연구원
이윤재 ( Lee Yoon-Jae ) - 자생한방병원 한방부인과
김지민 ( Kim Ji-Min ) - 한국보건의료연구원

Abstract

Objectives: This study aims to perform the systemic review and meta-analysis of the diagnostic accuracy of cervical cancer screening methods among asymptomatic women in Korea.

Methods: Studies were included if Papanicolaou smear test (PAP) or human papillomavirus DNA test (HPV) were conducted as index test among Koreans and published after 1995. We extracted sensitivity and specificity for the detection of cervical intraepithelial neoplasia 1 (CIN 1) or worse based on colposcopy and histology of colposcopy-targeted biopsies. Two independent reviewers appraised and rated the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-II). Summary receiver operating characteristic curve and bivariate random effects model were applied to synthesize diagnostic accuracy with 95% confidence interval (CI).

Results: Among 5,589 papers, 306 studies were met inclusion criteria. After excluding studies who had inconsistencies in study design, outcomes, or patients, 33 studies were finally included. When we rated the risk of bias, most were categorized into unclear in the selection and application criteria. Bivariate random effects meta analysis estimated the pooled sensitivity and specificity of 18 studies for PAP as 0.84 (95% CI, 0.75~0.90) and 0.78 (95% CI, 0.62~0.89), respectively for detecting atypical squamous cells of undetermined significance (ASCUS) or worse. In HPV test, based on 15 studies, the pooled sensitivity and specificity was 0.77 (95% CI, 0.64~0.84) and 0.79 (95% CI, 0.70~0.85), respectively.

Conclusion: PAP appeared to have a higher sensitivity than that of HPV. However, included studies had poor or unclear quality with respect to interpretation of the test results. More rigorous studies are needed.

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질병특성
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