Summary of findings 1. Summary of findings: occurrence of CIN and default rates.
| Immediate colposcopy compared with cytological surveillance for minor cervical cytological abnormalities: occurrence of different grades CIN in histology according to follow‐up time and default rates | ||||||
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Patient or population: women with ASCUS or LSIL Settings: colposcopy clinic Intervention: immediate colposcopy Comparison: cytological surveillance | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Risk with cytological surveillance | Risk with immediate colposcopy | |||||
| Occurrence of CIN2+ in histology at 18 months | 101 per 1000 | 151 per 1000 (113 to 203) | RR 1.50 (1.12 to 2.01) | 4028 (2 studies) | ⊕⊕⊕⊝ moderate1 | |
| Occurrence of CIN2+ in histology at 24 months | 183 per 1000 | 209 per 1000 (121 to 361) | RR 1.14 (0.66 to 1.97) | 4331 (3 studies) | ⊕⊕⊝⊝ low2,3 | |
| Occurrence of CIN3+ in histology at 18 months | 69 per 1000 | 86 per 1000 (53 to 137) | RR 1.24 (0.77 to 1.98) | 4028 (2 studies) | ⊕⊕⊕⊝ moderate4 | |
| Occurrence of CIN3+ in histology at 24 months | 119 per 1000 | 121 per 1000 (63 to 234) | RR 1.02 (0.53 to 1.97) | 4331 (3 studies) | ⊕⊕⊝⊝ low3,5 | |
| Occurrence of any CIN in histology at 24 months | 316 per 1000 | 639 per 1000 (420 to 974) | RR 2.02 (1.33 to 3.08) | 656 (2 studies) | ⊕⊕⊝⊝ low3,8 | |
| Default rates at 6 months | 63 per 1000 | 241 per 1000 (80 to 728) | RR 3.85 (1.27 to 11.63) | 5117 (3 study) | ⊕⊕⊕⊝ moderate6 |
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| Default rates at 12 months | 63 per 1000 | 413 per 1000 (93 to 1000) | RR 6.60 (1.49 to 29.29 | 5115 (3 studies) | ⊕⊕⊕⊝ moderate7 |
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| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). For default rates the relative effect is calculated between cytological surveillance versus immediate colposcopy. For histology the relative effect is calculated between immediate colposcopy versus cytological surveillance. ASCUS: atypical squamous cells of undetermined significance CI: Confidence interval; CIN: cervical intraepithelial neoplasia; LSIL: low‐grade squamous intra‐epithelial lesions; RR: Risk Ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Downgraded to moderate due to substantial inter‐study heterogeneity (P = 0.08, I2= 61%). 2 Downgraded to low due to considerable inter‐study heterogeneity (P < 0.00001, I2= 94%). 3 Downgraded due to presence of the other possible bias resulting in falsely high CIN detection rate in the cytological surveillance arm. 4 Downgraded to moderate due to substantial inter‐study heterogeneity (P = 0.02, I2= 75%). 5 Downgraded to low due to considerable inter‐study heterogeneity (P < 0.00001, I2= 93%). 6 Downgraded to moderate due to considerable inter‐study heterogeneity (P = 0.02, I2= 76%). 7 Downgraded to moderate due to considerable inter‐study heterogeneity (P = 0.0004, I2= 87%). 8 Downgraded to low due to substantial inter‐study heterogeneity (P = 0.02, I2 = 82%).