{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:34:50Z","timestamp":1790872490423,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2008,4,10]],"date-time":"2008-04-10T00:00:00Z","timestamp":1207785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cervical cancer is the main cancer among women in sub\u2010Saharan Africa, India and other parts of the developing world. Evaluation of screening performance of effective, feasible and affordable early detection and management methods is a public health priority. Five screening methods, naked eye visual inspection of the cervix uteri after application of diluted acetic acid (VIA), or Lugol's iodine (VILI) or with a magnifying device (VIAM), the Pap smear and human papillomavirus testing with the high\u2010risk probe of the Hybrid Capture\u20102 assay (HC2), were evaluated in 11 studies in India and Africa. More than 58,000 women, aged 25\u201364 years, were tested with 2\u20135 screening tests and outcome verification was done on all women independent of the screen test results. The outcome was presence or absence of cervical intraepithelial neoplasia (CIN) of different degrees or invasive cervical cancer. Verification was based on colposcopy and histological interpretation of colposcopy\u2010directed biopsies. Negative colposcopy was accepted as a truly negative outcome. VIA showed a sensitivity of 79% (95% CI 73\u201385%) and 83% (95% CI 77\u201389%), and a specificity of 85% (95% CI 81\u201389%) and 84% (95% CI 80\u201388%) for the outcomes CIN2+ or CIN3+, respectively. VILI was on average 10% more sensitive and equally specific. VIAM showed similar results as VIA. The Pap smear showed lowest sensitivity, even at the lowest cutoff of atypical squamous cells of undetermined significance (57%; 95% CI 38\u201376%) for CIN2+ but the specificity was rather high (93%; 95% CI 89\u201397%). The HC2\u2010assay showed a sensitivity for CIN2+ of 62% (95% CI 56\u201368%) and a specificity of 94% (95% CI 92\u201395%). Substantial interstudy variation was observed in the accuracy of the visual screening methods. Accuracy of visual methods and cytology increased over time, whereas performance of HC2 was constant. Results of visual tests and colposcopy were highly correlated. This study was the largest ever done that evaluates the cross\u2010sectional accuracy of screening tests for cervical cancer precursors in developing countries. The merit of the study was that all screened subjects were submitted to confirmatory investigations avoiding to verification bias. A major finding was the consistently higher sensitivity but equal specificity of VILI compared with VIA. Nevertheless, some caution is warranted in the interpretation of observed accuracy measures, since a certain degree of gold standard misclassification cannot be excluded. Because of the correlation between visual screening tests and colposcopy and a certain degree of over\u2010diagnosis of apparent CIN2+ by study pathologists, it is possible that both sensitivity and specificity of VIA and VILI were overestimated. Gold standard verification error could also explain the surprisingly low sensitivity of HC2, which contrasts with findings from other studies. \u00a9 2008 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ijc.23489","type":"journal-article","created":{"date-parts":[[2008,4,10]],"date-time":"2008-04-10T16:46:27Z","timestamp":1207845987000},"page":"153-160","source":"Crossref","is-referenced-by-count":224,"title":["Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India"],"prefix":"10.1002","volume":"123","author":[{"given":"Marc","family":"Arbyn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rengaswamy","family":"Sankaranarayanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Muwonge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namory","family":"Keita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amadou","family":"Dolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Gombe","family":"Mbalawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Nouhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boblewende","family":"Sakande","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramani","family":"Wesley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thara","family":"Somanathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surendra","family":"Shastri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parthasarathy","family":"Basu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,4,24]]},"reference":[{"key":"e_1_2_6_2_2","volume-title":"IARC CancerBase No. 5, version 2.0","author":"Ferlay J","year":"2004"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.11719"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.55.2.74"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2006.05.111"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.20190"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.11245"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cdp.2004.04.004"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1258\/096914104774061056"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.20396"},{"key":"e_1_2_6_11_2","series-title":"A Pooled Analysis of ACCP Trial Results IPH\/EPI\u2010REPORTS","first-page":"1","author":"Arbyn M","year":"2005"},{"key":"e_1_2_6_12_2","first-page":"1","volume-title":"A practical manual on visual screening for cervical neoplasia","author":"Sankaranarayanan R","year":"2003"},{"key":"e_1_2_6_13_2","first-page":"325","volume-title":"New developments in cervican cancer screening and prevention","author":"Lorincz AT","year":"1997"},{"key":"e_1_2_6_14_2","first-page":"9","article-title":"Meta\u2010analysis","author":"Sharp S","year":"1997","journal-title":"Stata Tech Bull"},{"key":"e_1_2_6_15_2","first-page":"317","volume-title":"Methods for meta\u2010analysis in medical research","author":"Sutton AJ","year":"2000"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.06.011"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.942"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxl004"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780121403"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.lgt.0000210126.08640.4e"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2005.01.035"},{"key":"e_1_2_6_22_2","first-page":"88","article-title":"Detection of CIN by naked eye visualization after application of acetic acid","volume":"34","author":"Londhe M","year":"1997","journal-title":"Indian J Cancer"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)07033-0"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.153"},{"key":"e_1_2_6_25_2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4103\/0019-509X.12342","article-title":"Visual inspection for cervical cancer screening: evaluation by doctors versus paramedical workers","volume":"41","author":"Bhatla N","year":"2004","journal-title":"Indian J Cancer"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20000815)89:4<826::AID-CNCR15>3.0.CO;2-5"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(00)00382-9"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1258\/0969141054855328"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21972"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.1.81"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2000.tb11576.x"},{"key":"e_1_2_6_32_2","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.2001.6370"},{"key":"e_1_2_6_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.22757"},{"key":"e_1_2_6_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.jncimonographs.a003488"},{"key":"e_1_2_6_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2006.08.053"},{"key":"e_1_2_6_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2006.05.117"},{"key":"e_1_2_6_37_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21955"},{"key":"e_1_2_6_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.11350"},{"key":"e_1_2_6_39_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602348"},{"key":"e_1_2_6_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000220505.18525.85"},{"key":"e_1_2_6_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.01.091"},{"key":"e_1_2_6_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.065"},{"key":"e_1_2_6_43_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.lgt.0000192694.85549.3d"},{"key":"e_1_2_6_44_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-7-36"},{"key":"e_1_2_6_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61195-7"},{"key":"e_1_2_6_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(07)60016-2"},{"key":"e_1_2_6_47_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2006.104273"}],"container-title":["International Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fijc.23489","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.23489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T10:48:48Z","timestamp":1695898128000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ijc.23489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,4,24]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2008,7]]}},"alternative-id":["10.1002\/ijc.23489"],"URL":"https:\/\/doi.org\/10.1002\/ijc.23489","archive":["Portico"],"relation":{},"ISSN":["0020-7136","1097-0215"],"issn-type":[{"value":"0020-7136","type":"print"},{"value":"1097-0215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,4,24]]}}}