Reporting and Assessing the Quality of Diagnostic Accuracy Studies for Cervical Cancer Screening and Management

Megan A. Clarke, Teresa M. Darragh, Erin Nelson, Elizabeth R. Unger, Rosemary Zuna, Miriam Cremer, Colleen K. Stockdale, Mark H. Einstein, Nicolas Wentzensen

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective We adapted the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for studies of cervical cancer screening and management and used the adapted tool to evaluate the quality of studies included in a systematic review supporting the 2019 Risk-Based Management Consensus Guidelines. Methods We evaluated the quality of all studies included in our systematic review for postcolposcopy (n = 5) and posttreatment (n = 23) surveillance using QUADAS-2 criteria. Subsequently, we adapted signaling questions to indications of cervical cancer screening and management. An iterative process was carried out to evaluate interrater agreement between 2 study authors (M.A.C. and N.W.). Discrepant ratings were discussed, and criteria were adapted accordingly. We also evaluated the influence of study quality on risk estimates and between study variation using stratified subgroup meta-analyses. Results Twelve signaling questions for bias assessment that were adapted to or newly developed for cervical cancer screening and management are described here. Interrater agreement on bias assessment increased from 70% to 83% during the adaptation process. Detailed assessment of bias and applicability showed that all studies on postcolposcopy management and 90% of studies on posttreatment management had high risk of bias in at least 1 domain. Most commonly, high risk of bias was observed for the patient selection domain, indicating the heterogeneity of study designs and clinical practice in reported studies. Conclusions The adapted QUADAS-2 will have broad application for researchers, evidence evaluators, and journals who are interested in designing, conducting, evaluating, and publishing studies for cervical cancer screening and management.

Original languageEnglish (US)
Pages (from-to)157-166
Number of pages10
JournalJournal of Lower Genital Tract Disease
Volume24
Issue number2
DOIs
StatePublished - Apr 1 2020
Externally publishedYes

Keywords

  • QUADAS
  • cervical cancer screening and management
  • guidelines
  • quality assessment
  • systematic review

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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