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Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate

Arbyn, Marc; Martin-Hirsch, Pierre; Buntinx, Frank; Van Ranst, Marc; Paraskevaidis, Evangelos and Dillner, Joakim LU (2009) In Journal of Cellular and Molecular Medicine 13(4). p.648-659
Abstract
Introduction Methods Results Discussion Conclusion Consistent evidence underlines the utility of human papillomavirus (HPV) DNA testing in the management of women with equivocal cervical cytological abnormalities, but not in case of low-grade lesions. We performed a meta-analysis including studies where the high-risk probe of the Hybrid Capture-II is used to triage these two cytological categories. The triage test-positivity rate reflects the colposcopy referral workload.Data were pooled on the HPV test positivity rate in women with atypical squamous cells of undetermined significance (ASCUS/ASC-US) or low-grade squamous intraepithelial lesions (LSIL), derived from different cytological classification systems. The meta-analysis was... (More)
Introduction Methods Results Discussion Conclusion Consistent evidence underlines the utility of human papillomavirus (HPV) DNA testing in the management of women with equivocal cervical cytological abnormalities, but not in case of low-grade lesions. We performed a meta-analysis including studies where the high-risk probe of the Hybrid Capture-II is used to triage these two cytological categories. The triage test-positivity rate reflects the colposcopy referral workload.Data were pooled on the HPV test positivity rate in women with atypical squamous cells of undetermined significance (ASCUS/ASC-US) or low-grade squamous intraepithelial lesions (LSIL), derived from different cytological classification systems. The meta-analysis was restricted to studies, published between 1991 and 2007. A random-effect model was applied for meta-analytical pooling and the influence of covariates on the HPV positivity rate was analyzed by meta-regression. The variation by age was assessed within individual studies since age strata were not defined uniformly. On an average, 43% (95% CI: 40-46%) of women with ASCUS/ASC-US were high-risk HPV positive (range 23-74%). In women with LSIL, the pooled positivity rate was 76% (95% CI: 71-81%; range 55-89%). In spite of considerable inter-study heterogeneity, the difference in HPV positivity between the two triage groups was large and highly significant: 32% (95% CI: 27-38%). HPV rates dropped tremendously as age and cutoffs of test positivity increased. Other factors (cytological classification system, country, continent, collection method and year of publication) had no statistically significant impact, except in LSIL triage where HPV positivity was significantly lower in European compared to American studies. Women with LSIL, especially younger women, have high HPV positivity rates suggesting limited utility of reflex HPV triaging these cases. Research is needed to identify more specific methods to triage women with low-grade squamous cervical lesions. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
papillomavirus, human, triage, low-grade squamous intraepithelial lesions, cervical cancer, atypical squamous cells of undetermined significance, meta-analysis, HPV
in
Journal of Cellular and Molecular Medicine
volume
13
issue
4
pages
648 - 659
publisher
Wiley-Blackwell
external identifiers
  • wos:000265427300005
  • scopus:65249165605
ISSN
1582-1838
DOI
10.1111/j.1582-4934.2008.00631.x
language
English
LU publication?
yes
id
c0be1039-cbe1-4673-b504-a2e1b36a356a (old id 1399497)
date added to LUP
2009-06-15 15:15:01
date last changed
2017-11-19 03:28:52
@article{c0be1039-cbe1-4673-b504-a2e1b36a356a,
  abstract     = {Introduction Methods Results Discussion Conclusion Consistent evidence underlines the utility of human papillomavirus (HPV) DNA testing in the management of women with equivocal cervical cytological abnormalities, but not in case of low-grade lesions. We performed a meta-analysis including studies where the high-risk probe of the Hybrid Capture-II is used to triage these two cytological categories. The triage test-positivity rate reflects the colposcopy referral workload.Data were pooled on the HPV test positivity rate in women with atypical squamous cells of undetermined significance (ASCUS/ASC-US) or low-grade squamous intraepithelial lesions (LSIL), derived from different cytological classification systems. The meta-analysis was restricted to studies, published between 1991 and 2007. A random-effect model was applied for meta-analytical pooling and the influence of covariates on the HPV positivity rate was analyzed by meta-regression. The variation by age was assessed within individual studies since age strata were not defined uniformly. On an average, 43% (95% CI: 40-46%) of women with ASCUS/ASC-US were high-risk HPV positive (range 23-74%). In women with LSIL, the pooled positivity rate was 76% (95% CI: 71-81%; range 55-89%). In spite of considerable inter-study heterogeneity, the difference in HPV positivity between the two triage groups was large and highly significant: 32% (95% CI: 27-38%). HPV rates dropped tremendously as age and cutoffs of test positivity increased. Other factors (cytological classification system, country, continent, collection method and year of publication) had no statistically significant impact, except in LSIL triage where HPV positivity was significantly lower in European compared to American studies. Women with LSIL, especially younger women, have high HPV positivity rates suggesting limited utility of reflex HPV triaging these cases. Research is needed to identify more specific methods to triage women with low-grade squamous cervical lesions.},
  author       = {Arbyn, Marc and Martin-Hirsch, Pierre and Buntinx, Frank and Van Ranst, Marc and Paraskevaidis, Evangelos and Dillner, Joakim},
  issn         = {1582-1838},
  keyword      = {papillomavirus,human,triage,low-grade squamous intraepithelial lesions,cervical cancer,atypical squamous cells of undetermined significance,meta-analysis,HPV},
  language     = {eng},
  number       = {4},
  pages        = {648--659},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Cellular and Molecular Medicine},
  title        = {Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate},
  url          = {http://dx.doi.org/10.1111/j.1582-4934.2008.00631.x},
  volume       = {13},
  year         = {2009},
}