Fifteen articles (22 studies, 101,299 participants) were included in the review. QUADAS scores ranged from 11 to 13 and STARD scores ranged from 18 to 24.
For visual inspection with acetic acid (20 studies, 99,972 participants), pooled estimate of sensitivity was 77% (95% CI 75 to 78%; Ι²=91.1%) and specificity was 87% (95% CI 83 to 87%; Ι²=99.7%). The pooled DOR was 27.63 (95% CI 13.93 to 37.45; Ι²=95.9%). Regression analysis indicated that the region in which the study was conducted and the sample size significantly affected estimates of test performance.
For magnified visual inspection with acetic acid (three studies, 26,751 participants), pooled estimate of sensitivity was 64% (95% CI 59 to 68%), Ι²=0% and specificity was 85% (95% CI 85 to 86%: Ι²=94.6%). The pooled DOR was 10.35 (95% CI 7.73 to 13.87; Ι²=49.3%). No regression analysis was conducted.
For visual inspection with Lugol iodine (15 studies, 81,706 participants), pooled estimate of sensitivity was 91% (95% CI 89 to 92%; Ι²=90.5%) and specificity was 85% (95% CI 85 to 86%; Ι²=99.7%). The pooled DOR was 60.83 (95% CI 32.85 to 112.67; Ι²=92.3%). Regression analysis indicated that the region in which the study was conducted significantly affected estimates of test performance.
For human papillomavirus testing with Hybrid Capture 2 assay (seven studies, 23,628 participants), pooled estimate of sensitivity was 74% (95% CI 69 to 78%; Ι²=87.7%) and specificity was 92% (95% CI 92 to 93%; Ι²=98.2%). The pooled DOR was 33.26 (95% CI 19.38 to 57.08; Ι²=81.9%). No regression analysis was conducted.
For conventional Papanicolaou smear (seven studies, 43,993 participants), pooled estimate of sensitivity was 59% (95% CI 56 to 62%; Ι²=94.9%) and specificity was 94% (95% CI 94 to 94%; Ι²=94.9%). The pooled DOR was 22.49 (95% CI 11.16 to 45.31; Ι²=92.5%). No regression analysis was conducted.
For thin liquid-based cytology (three studies, 4,719 participants), pooled estimate of sensitivity was 88% (95% CI 83 to 91%; Ι²=67.1%) and specificity was 88% (95% CI 87 to 89%; Ι²=99.5%). The pooled DOR was 51.56 (95% CI 11.30 to 235.18; Ι²=92.5%). No regression analysis was conducted.