Fluorescence spectroscopy for diagnosis of squamous intraepithelial lesions of the cervix

Objective: To calculate receiver operating characteristic (ROC) curves for fluorescence spectroscopy in order to measure its performance in the diagno sis of squamous intraepithelial lesions (SILs) and to compare these curves with those for other diagnostic methods: colposcopy, cervicography, speculo scopy, Papanicolaou smear screening, and human papillomavirus (HPV) testing . Data Sources: Data from our previous clinical study were used to calculate ROC curves for fluorescence spectroscopy. Curves for other techniques were calculated from other investigators' reports. To identify these, a MEDLINE search for articles published from 1966 to 1996 was carried out, using the search terms "colposcopy," "cervicoscopy," "cervicography," "speculoscopy," "Papanicolaou smear," "HPV testing," "fluorescence spectroscopy," and "pol ar probe" in conjunction with the terms "diagnosis," "positive predictive v alue," "negative predictive value," and "receiver operating characteristic curve." Methods of Study Selection: We found 270 articles, from which articles were selected if they reported results of studies involving high-disease-preval ence populations, reported findings of studies in which colposcopically dir ected biopsy was the criterion standard, and included sufficient data for r ecalculation of the reported sensitivities and specificities. Tabulation, Integration, and Results: We calculated ROC curves for fluoresc ence spectroscopy using Bayesian and neural net algorithms. A meta-analytic approach was used to calculate ROC curves for the other techniques. Areas under the curves were calculated. Fluorescence spectroscopy using the neura l net algorithm had the highest area under the ROC curve, followed by fluor escence spectroscopy using the Bayesian algorithm, followed by colposcopy, the standard diagnostic technique. Cervicography, Papanicolaou smear screen ing, and HPV testing performed comparably with each other but not as well a s fluorescence spectroscopy and colposcopy. Conclusion: Fluorescence spectroscopy performs better than colposcopy and o ther techniques in the diagnosis of SILs. Because it also permits real-time diagnosis and has the potential of being used by inexperienced health care personnel, this technology holds bright promise. (C) 1999 by The American College of Obstetricians and Gynecologists.