Cervicography for cervical cancer screening : A systematic review and meta-analysis
4 affiliations
- 1Konkuk University College of Medicine, Seoul, Republic of Korea
- 2Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
- 3Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
- 4Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Abstract
Background:: Cervicography (CVG) has been proposed as a low-cost adjunct to Papanicolaou (Pap) cytology, but its added value as a co-test is uncertain. We evaluated the accuracy of CVG and Pap cytology, alone and as a parallel combined test, for histologically confirmed cervical intraepithelial neoplasia grade 2 or worse.
Methods:: Five databases were searched for studies published through December 31, 2024, without geographical or language restriction. The reference standard was histopathology of colposcopy-directed biopsy. Sensitivity and specificity were pooled with a bivariate random-effects model. Because both index tests were applied to the same participants in every study, they were compared within a single paired model yielding relative sensitivity, relative specificity and the relative diagnostic odds ratio (rDOR).
Results:: Eight cross-sectional studies were included. Pooled sensitivity and specificity were 0.69 (95% confidence interval 0.59–0.77) and 0.90 (0.83–0.95) for CVG, and 0.69 (0.56–0.80) and 0.96 (0.91–0.98) for Pap cytology. In the paired comparison, relative sensitivity was 1.01 (0.92–1.11; P = .87), relative specificity 0.94 (0.91–0.98; P = .002) and the rDOR 0.43 (0.31–0.60; P < .001). In the 3 studies also reporting the combination, its rDOR versus Pap cytology was 1.48 (0.72–3.08; P = .29). Heterogeneity was substantial, but the comparison was stable on leave-one-out analysis (relative specificity 0.93–0.96).
Conclusions:: CVG did not improve sensitivity over Pap cytology, and both its specificity and its overall accuracy were lower. Adding CVG raised sensitivity, but this follows from the parallel testing rule: the gain in overall accuracy was not statistically significant, while false positives increased approximately 3-fold. Given the very low certainty of the evidence, routine addition of CVG to Pap cytology cannot be recommended. Prospective studies of digital tele-CVG against human papillomavirus-based strategies are required.
Related
- 2022 WHO estimates for overall and human papillomavirus test-based cervical cancer screening coverage worldwide: a review and synthetic analysis
- Artificial intelligence-based tongue image analysis for non-invasive screening of gastric cancer, precancerous lesions, and related gastrointestinal disorders: a systematic review
- Systematic review and meta-analysis of lung metastases incidence in cervical cancer patients
- Predicting outcomes in locally advanced cervical cancer treated with radiotherapy: a systematic review of nomograms
- The efficacy and safety of neoadjuvant chemotherapy plus immune check point inhibitors for locally advanced cervical cancer: a systematic review and meta-analysis.
BibTeX
@article{kim2026cervicography,
title = {{Cervicography for cervical cancer screening : A systematic review and meta-analysis}},
author = {Soo-Nyung Kim and Seung-Hyuk Shim and Jaeman Bae and Ju-Hyun Kim and Tae-Jin Kim},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051370},
url = {https://europepmc.org/article/PMC/PMC13727180},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Cervicography for cervical cancer screening : A systematic review and meta-analysis
AU - Soo-Nyung Kim
AU - Seung-Hyuk Shim
AU - Jaeman Bae
AU - Ju-Hyun Kim
AU - Tae-Jin Kim
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051370
UR - https://europepmc.org/article/PMC/PMC13727180
AB - Background:: Cervicography (CVG) has been proposed as a low-cost adjunct to Papanicolaou (Pap) cytology, but its added value as a co-test is uncertain. We evaluated the accuracy of CVG and Pap cytology, alone and as a parallel combined test, for histologically confirmed cervical intraepithelial neoplasia grade 2 or worse. Methods:: Five databases were searched for studies published through December 31, 2024, without geographical or language restriction. The reference standard was histopathology of colposcopy-directed biopsy. Sensitivity and specificity were pooled with a bivariate random-effects model. Because both index tests were applied to the same participants in every study, they were compared within a single paired model yielding relative sensitivity, relative specificity and the relative diagnostic odds ratio (rDOR). Results:: Eight cross-sectional studies were included. Pooled sensitivity and specificity were 0.69 (95% confidence interval 0.59–0.77) and 0.90 (0.83–0.95) for CVG, and 0.69 (0.56–0.80) and 0.96 (0.91–0.98) for Pap cytology. In the paired comparison, relative sensitivity was 1.01 (0.92–1.11; P = .87), relative specificity 0.94 (0.91–0.98; P = .002) and the rDOR 0.43 (0.31–0.60; P < .001). In the 3 studies also reporting the combination, its rDOR versus Pap cytology was 1.48 (0.72–3.08; P = .29). Heterogeneity was substantial, but the comparison was stable on leave-one-out analysis (relative specificity 0.93–0.96). Conclusions:: CVG did not improve sensitivity over Pap cytology, and both its specificity and its overall accuracy were lower. Adding CVG raised sensitivity, but this follows from the parallel testing rule: the gain in overall accuracy was not statistically significant, while false positives increased approximately 3-fold. Given the very low certainty of the evidence, routine addition of CVG to Pap cytology cannot be recommended. Prospective studies of digital tele-CVG against human papillomavirus-based strategies are required.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -