High-risk human papillomavirus testing versus cytology in predicting post-treatment disease in women treated for high-grade cervical disease: A systematic review and meta-analysis

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• 作者：Marië ; lle Kocken^a ; ^b ; ¹ ; ^{m.kocken@vumc.nl} ; Margot H. Uijterwaal^a ; ¹ ; Anton L.M. de Vries^c ; Johannes Berkhof^c ; Johannes C.F. Ket^d ; Theo J.M. Helmerhorst^b ; Chris J.L.M. Meijer^a
• 关键词：Cervical Intraepithelial Neoplasia (CIN) ; Conization ; Cytology ; Human papillomavirus (HPV) ; Diagnostic accuracy ; Recurrence
• 刊名：Gynecologic Oncology
• 出版年：2012
• 期刊代码：295_00908258
• 类别：med
• 出版时间：May, 2012
• 卷：125
• 期：2
• 页码：500-507
• 文件大小：741 K

摘要

Objective

Currently, women treated for high-grade cervical intraepithelial neoplasia (CIN 2/3) are followed-up by cytology to monitor them for residual and recurrent (post-treatment) disease. This systematic review and meta-analysis determine the test performance of testing for high-risk types of the human papillomavirus (hrHPV), cytology and co-testing (combined hrHPV testing and cytology) in predicting high-grade post-treatment disease (CIN2+).

Methods

Studies that compared at least two of three post-treatment surveillance methods, and were published between January 2003 and May 2011, were identified through a bibliographic database search (PubMed, Embase.com and Wiley/Cochrane Library). Identification of relevant studies was conducted independently by two reviewers with a multi-step process. The reference standard used to diagnose post-treatment disease was histologically confirmed CIN2+.

Sensitivity, specificity, diagnostic odds ratios and relative sensitivity and specificity were calculated for each study. Pooled estimates were calculated using a random effects model if heterogeneity among studies was significant, otherwise by using a fixed effects model. Estimates were reported with 95%confidence intervals (95%CI).

Results

Out of 2410 potentially relevant citations, 8 publications, incorporating 1513 treated women, were included. Pooled sensitivities were 0.79 (95%CI 0.72-0.85) for cytology, 0.92 (0.87-0.96) for hrHPV testing, and 0.95 (0.91-0.98) for co-testing. HrHPV testing was more sensitive than cytology to predict post-treatment CIN2+ (relative sensitivity 1.15; 95%CI 1.06-1.25). Pooled specificities were 0.81 (95%CI 0.74-0.86) for cytology, 0.76 (0.67-0.84) for hrHPV testing and 0.67 (0.60-0.74) for co-testing. HrHPV testing and cytology had a similar specificity (relative specificity 0.95, 95%CI 0.88-1.02).

Conclusions

This review indicates that the hrHPV test should be included in post-treatment testing 6 months after treatment, because hrHPV testing has a higher sensitivity than cytology in detecting high-grade post-treatment disease and has a similar specificity.