Comparison Of The Diagnostic Accuracy Between Two Diagnostic Methods In Patients With Cervical Intraepithelial Neoplasia And Stage Ia Cervical Carcinoma

Background: Cervical carcinoma has a natural history of about 10 years. If recognized and diagnosed early as the pre-cancerous lesions and stage Ia cervical carcinoma, the mortality of cervical carcinoma could be greatly reduced. Colposcopically directed biopsy and diagnostic cone biopsy are two important diagnostic methods. However, the diagnostic accuracy of these two methods differs in different trials. Objectives: To evaluate the sensitivity, specificity, accuracy, negative and positive predictive value, negative and positive likelihood ratio of colposcopically directed biopsy and diagnostic cone biopsy in patients with cervical intraepithelial neoplasia and stage la cervical carcinoma. Search Strategy: Electronic databases: Medline, Cochrane Library(2003 issue 4); CMB disc, CMCC, CNKI, VIP. Date of most recent searches: March 2004. Selection Criteria: Trials with available data which employed colposcopically directed biopsy or diagnosic cone biopsy, compared with golden standard (pathological diagnosis of specimens obtained through therapeutic conization or hysterectomy). Participants were patients clinically suspected of pre-cancerous cervical lesions or cervical carcinoma. Data collection and analysis: Two reviwers independently selected trials for inclusion, assessed trial quality, extracted the data and performed the analysis. Main Results: Twenty-eight trialssatisfied the inclusion criteria. The accuracy of diagnosis made through colposcopically directed biopsy was compared with that made through diagnostic cone biopsy concerning the diagnosis of all positive cases (from CIN-I to la), which suggested an inconsistency before and after sensitivity analysis, rendering no definite conclusion as to which is superior of these two diagnostic methods. Statistically significant advantage of diagnostic cone biopsy over colposcopically directed biopsy was suggested concerning the diagnosis of stage la cervical carcinoma. The quality of the trial reports was generally poor. Reviewers' Conclusions: Concerning the diagnosis of all positive cases, no definite conclusion could be made as to which is superior of colposcopically directed biopsy and diagnostic cone biopsy. Diagnositc cone biopsy is justified for the diagnosis of stage la cervical carcinoma; however, this conclusion requires more trials of high quality for supporting.