Adjunctive colposcopy technologies for assessing suspected cervical abnormalities: systematic reviews and economic...

Area of Science:

• Gynecologic Oncology
• Medical Imaging Technology
• Health Technology Assessment

Background:

• Cervical intraepithelial neoplasia (CIN) and cancer detection can be improved with adjunctive technologies.
• Dynamic Spectral Imaging System (DySIS) and ZedScan are advanced imaging systems used with colposcopy.

Purpose of the Study:

• To systematically review the evidence on diagnostic accuracy, clinical effectiveness, and implementation of DySIS and ZedScan.
• To develop a cost-effectiveness model for these adjunctive technologies in cervical cancer screening.

Main Methods:

• Four parallel systematic reviews were conducted on diagnostic accuracy, clinical effectiveness, implementation, and economic analyses.
• Studies were searched from January 2017 using databases like MEDLINE and EMBASE.
• A patient-level state-transition model was developed for cost-effectiveness evaluation under HPV triage or primary screening algorithms.

Main Results:

• Adjunctive DySIS demonstrated higher sensitivity (81.25%) but lower specificity (70.40%) for CIN 2+ compared to standard colposcopy.
• DySIS was found to be cost-effective, dominating standard colposcopy in most scenarios.
• ZedScan also showed potential cost-effectiveness, particularly for high-grade referrals in see-and-treat clinics.

Conclusions:

• DySIS enhances CIN 2+ detection sensitivity but reduces specificity, potentially leading to over-diagnosis.
• Evidence for ZedScan is limited but suggests increased sensitivity and decreased specificity.
• Both DySIS and ZedScan appear cost-effective adjuncts to standard colposcopy within NHS value thresholds.