Alternative Colposcopy Techniques

OBJECTIVE: To assess the diagnostic value of alternative (digital) colposcopy techniques for detection of cervical intraepithelial neoplasia (CIN) 2 or worse in a colposcopy population. DATA SOURCES: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Library were searched from inception up to January 11, 2016, for studies that evaluated the diagnostic value of alternative (digital) colposcopy techniques. METHODS OF STUDY SELECTION: Inclusion criteria were: 1) an alternative (digital) colposcopy technique was used in a colposcopy population; 2) a histologic outcome was reported, classified as CIN, differentiating between mild dysplasia or less (CIN 1 or less), and moderate dysplasia or worse (CIN 2 or greater); 3) the entire cervix was scanned at once or a per-woman analysis was performed; 4) no other topical application than acetic acid and Lugol's solution was used; 5) at least three eligible studies had to be available within a single technique; and 6) studies obtained research ethics approval. Language was restricted to English. TABULATION, INTEGRATION, AND RESULTS: Two reviewers assessed the eligibility of the identified articles. Disagreements were resolved by a third reviewer. Thirteen studies met the inclusion criteria. We found six studies on fluorescence and reflectance spectroscopy, including 2,530 women, with a pooled sensitivity of 93% (95% confidence interval [CI] 89–95%) and specificity of 62% (95% CI 47–76%). Four studies on dynamic spectral imaging were found including 1,173 women with a pooled sensitivity of 69% (95% CI 48–85%) and specificity of 83% (95% CI 76–88%). We found three studies on optical coherence tomography including 693 women with a pooled sensitivity of 48% (95% CI 32–64%) and specificity of 77% (95% CI 52–91%). Previously published conventional colposcopy results showed a sensitivity of 61% (95% CI 58–63%) and a specificity of 85% (95% CI 83–86%). CONCLUSION: Alternative (digital) colposcopy techniques may result in increased sensitivity and specificity, but no recommendation for introduction in clinical practice can be made yet.