Screening for squamous intraepithelial lesions with fluorescence spectroscopy

Objective: To evaluate the accuracy of fluorescence spectroscopy in screeni ng for squamous intraepithelial lesions (SILs) and to compare its performan ce with that of Papanicolaou smear screening, colposcopy, cervicoscopy, cer vicography, and human papillomavirus (HPV) testing. Data Sources: Receiver operating characteristic (ROC) curve analysis was us ed to analyze performance by fluorescence spectroscopy (primary data) and o ther methods (secondary data). Methods of Study Selection: In our search, 275 articles were identified in MEDLINE (1966-1996). Articles were included if the investigators had studie d a population in whom low disease prevalence was expected; used either Pap anicolaou smear screening and colposcopy or colposcopically directed biopsy as a standard against which the screening technique was measured, and incl uded enough data for recalculation of reported sensitivities and specificit ies. Tabulation, Integration, and Results: Receiver operating characteristic cur ves for fluorescence spectroscopy were calculated using a Bayesian algorith m, and ROC curves for the other screening methods were constructed using me taanalytic techniques. Areas under the ROC curves and Q points were calcula ted. Screening colposcopy had the highest area under the curve (0.95), foll owed by screening cervicography (0.90), HPV testing (0.88), cervicoscopy (0 .85), fluorescence spectroscopy (0.76), and Papanicolaou smear screening (0 .70). Conclusion: In terms of screening for SILs, fluorescence spectroscopy perfo rmed better than the standard technique, Papanicolaou smear screening, and less well than screening colposcopy, cervicography, HPV testing, and cervic oscopy. The promise of this research technique warrants further investigati on. (Obstet Gynecol 1999;94:889-96. (C) 1999 by The American College of Obs tetricians and Gynecologists.).