© 2004 by Oxford University Press
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2004 Oxford University Press
ARTICLE |
Virologic Versus Cytologic Triage of Women With Equivocal Pap Smears: A Meta-analysis of the Accuracy To Detect High-Grade Intraepithelial Neoplasia
Affiliations of authors: European Network for Cervical Cancer Screening and Unit for Evaluation of Cancer Screening Programmes, Scientific Institute of Public Health, Brussels, Belgium (MA); Centre for Evidence Based Medicine, Belgian Branch of the Cochrane Collaboration, Department of General Practice, University of Leuven, Leuven, Belgium, and University of Maastricht, Maastricht, The Netherlands (FB); Department of Clinical and Epidemiological Virology, University of Leuven (MVR); Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece (EP); Central Lancashire Teaching Hospitals, Preston, UK (PMH); Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö, Sweden (JD).
Correspondence to: Marc Arbyn, MD, MSc, Scientific Institute of Public Health, J. Wytsmanstreet 14, B1050 Brussels, Belgium (e-mail: marc.arbyn{at}iph.fgov.be)
Background: The appropriate management of women with minor cytologic lesions in their cervix is unclear. We performed a meta-analysis to assess the accuracy of human papillomavirus (HPV) DNA testing as an alternative to repeat cytology in women who had equivocal results on a previous Pap smear. Methods: Data were extracted from articles published between 1992 and 2002 that contained results of virologic and cytologic testing followed by colposcopically directed biopsy in women with an index smear showing atypical cells of undetermined significance (ASCUS). Fifteen studies were identified in which HPV triage and the histologic outcome (presence or absence of a cervical intraepithelial neoplasia of grade II or worse [CIN2+]) was documented. Nine, seven, and two studies also documented the accuracy of repeat cytology when the cutoff for abnormal cytology was set at a threshold of ASCUS or worse, low-grade squamous intraepithelial lesion (LSIL) or worse, or high-grade squamous intraepithelial lesion (HSIL) or worse, respectively. Random-effects models were used for pooling of accuracy parameters in case of interstudy heterogeneity. Differences in accuracy were assessed by pooling the ratio of the sensitivity (or specificity) of HPV testing to that of repeat cytology. Results: The sensitivity and specificity were 84.4% (95% confidence interval [CI] = 77.6% to 91.1%) and 72.9% (95% CI = 62.5% to 83.3%), respectively, for HPV testing overall and 94.8% (95% CI = 92.7% to 96.9%) and 67.3% (95% CI = 58.2% to 76.4%), respectively, for HPV testing in the eight studies that used the Hybrid Capture II assay. Sensitivity and specificity of repeat cytology at a threshold for abnormal cytology of ASCUS or worse was 81.8% (95% CI = 73.5% to 84.3%) and 57.6% (95% CI = 49.5% to 65.7%), respectively. Repeat cytology that used higher cytologic thresholds yielded substantially lower sensitivity but higher specificity than triage with the Hybrid Capture II assay. The ratio of the sensitivity of the Hybrid Capture II assay to that of repeat cytology at a threshold of ASCUS or worse pooled from the four studies that used both triage tests was 1.16 (95% CI = 1.04 to 1.29). The specificity ratio was not statistically different from unity. Conclusion: The published literature indicates that the Hybrid Capture II assay has improved accuracy (higher sensitivity, similar specificity) than the repeat Pap smear using the threshold of ASCUS for an outcome of CIN2+ among women with equivocal cytologic results. The sensitivity of triage at higher cytologic cutoffs is poor.
CiteULike 
Connotea 
Del.icio.us What's this?
Editorial about this Article
- Have We Resolved How To Triage Equivocal Cervical Cytology?
- Diane Solomon and Mark Schiffman
J Natl Cancer Inst 2004 96: 250-251.[Extract] [Full Text] [PDF]
This article has been cited by other articles:
|
|
 |
|
  G. A.V. Boulet, I. H. Benoy, C. E. Depuydt, C. A.J. Horvath, M. Aerts, N. Hens, A. J. Vereecken, and J. J. Bogers Human Papillomavirus 16 Load and E2/E6 Ratio in HPV16-Positive Women: Biomarkers for Cervical Intraepithelial Neoplasia >=2 in a Liquid-Based Cytology Setting? Cancer Epidemiol. Biomarkers Prev., November 1, 2009; 18(11): 2992 - 2999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Siebers, P. J. J. M. Klinkhamer, J. M. M. Grefte, L. F. A. G. Massuger, J. E. M. Vedder, A. Beijers-Broos, J. Bulten, and M. Arbyn Comparison of Liquid-Based Cytology With Conventional Cytology for Detection of Cervical Cancer Precursors: A Randomized Controlled Trial JAMA, October 28, 2009; 302(16): 1757 - 1764. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Naucler, W. Ryd, S. Tornberg, A. Strand, G. Wadell, K. Elfgren, T. Radberg, B. Strander, O. Forslund, B.-G. Hansson, et al. Efficacy of HPV DNA Testing With Cytology Triage and/or Repeat HPV DNA Testing in Primary Cervical Cancer Screening J Natl Cancer Inst, January 21, 2009; 101(2): 88 - 99. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arbyn, I. Benoy, C. Simoens, J. Bogers, P. Beutels, and C. Depuydt Prevaccination Distribution of Human Papillomavirus Types in Women Attending at Cervical Cancer Screening in Belgium Cancer Epidemiol. Biomarkers Prev., January 1, 2009; 18(1): 321 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Arbyn, M Kyrgiou, C Simoens, A O Raifu, G Koliopoulos, P Martin-Hirsch, W Prendiville, and E Paraskevaidis Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis BMJ, September 18, 2008; 337(sep18_1): a1284 - a1284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Monsonego, G. Pollini, M. J. Evrard, P. Sednaoui, L. Monfort, D. Quinzat, R. Dachez, and K. Syrjanen Linear array genotyping and hybrid capture II assay in detecting human papillomavirus genotypes in women referred for colposcopy due to abnormal Papanicolaou smear Int J STD AIDS, June 1, 2008; 19(6): 385 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G A V Boulet, C A J Horvath, S Berghmans, L M Moeneclaey, I S M Duys, M Arbyn, C E Depuydt, A J Vereecken, S Sahebali, and J J Bogers Cervical cytology biobanking: quality of DNA from archival cervical Pap-stained smears J. Clin. Pathol., May 1, 2008; 61(5): 637 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. L Franco Human Papillomavirus and Cervical Cancer: Integrating the New Prevention Strategies Am. Assoc. Cancer Res. Educ. Book, April 12, 2008; 2008(1): 367 - 373. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A.V. Boulet, C. A.J. Horvath, S. Berghmans, and J. Bogers Human Papillomavirus in Cervical Cancer Screening: Important Role as Biomarker Cancer Epidemiol. Biomarkers Prev., April 1, 2008; 17(4): 810 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Nishiwaki, T. Yamamoto, S. Tone, T. Murai, T. Ohkawara, T. Matsunami, M. Koizumi, Y. Takagi, J. Yamaguchi, N. Kondo, et al. Genotyping of Human Papillomaviruses by a Novel One-Step Typing Method with Multiplex PCR and Clinical Applications J. Clin. Microbiol., April 1, 2008; 46(4): 1161 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. van Hamont, J. Bulten, H. Shirango, W.J.G. Melchers, L.F.A.G. Massuger, and P.C.M. de Wilde Biological behavior of CIN lesions is predictable by multiple parameter logistic regression models Carcinogenesis, April 1, 2008; 29(4): 840 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Fontaine, C. Mascaux, C. Weyn, A. Bernis, N. Celio, P. Lefevre, L. Kaufman, and C. Garbar Evaluation of Combined General Primer-Mediated PCR Sequencing and Type-Specific PCR Strategies for Determination of Human Papillomavirus Genotypes in Cervical Cell Specimens J. Clin. Microbiol., March 1, 2007; 45(3): 928 - 934. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ronco, N. Segnan, P. Giorgi-Rossi, M. Zappa, G. P. Casadei, F. Carozzi, P. D. Palma, A. Del Mistro, S. Folicaldi, A. Gillio-Tos, et al. Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized controlled trial. J Natl Cancer Inst, June 7, 2006; 98(11): 765 - 774. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Legood, A. Gray, J. Wolstenholme, and S. Moss Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: results of the NHS pilot studies BMJ, January 14, 2006; 332(7533): 79 - 85. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Sawaya A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance JAMA, November 2, 2005; 294(17): 2210 - 2218. [Full Text] [PDF]
|
|
|
|
|
|
S. S. Wang, J. L. Walker, M. Schiffman, D. Solomon, and for the Atypical Squamous Cell of Undetermined Sig Evaluating the Risk of Cervical Precancer with a Combination of Cytologic, Virologic, and Visual Methods Cancer Epidemiol. Biomarkers Prev., November 1, 2005; 14(11): 2665 - 2668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schiffman, M. J. Khan, D. Solomon, R. Herrero, S. Wacholder, A. Hildesheim, A. C. Rodriguez, M. C. Bratti, C. M. Wheeler, R. D. Burk, et al. A Study of the Impact of Adding HPV Types to Cervical Cancer Screening and Triage Tests J Natl Cancer Inst, January 19, 2005; 97(2): 147 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arbyn, J. Dillner, M. Van Ranst, F. Buntinx, P. Martin-Hirsch, and E. Paraskevaidis Re: Have We Resolved How To Triage Equivocal Cervical Cytology? J Natl Cancer Inst, September 15, 2004; 96(18): 1401 - 1402. [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Harper Why Am I Scared of HPV? CA Cancer J Clin, September 1, 2004; 54(5): 245 - 247. [Full Text] [PDF]
|
|
|
|
|
|
D. Solomon and M. Schiffman Have We Resolved How To Triage Equivocal Cervical Cytology? J Natl Cancer Inst, February 18, 2004; 96(4): 250 - 251. [Full Text] [PDF]
|
|