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

Arbyn M, Martin-Hirsch P, Buntinx F, Van Ranst M, Paraskevaidis E, Dillner J - J. Cell. Mol. Med. (2009)

Bottom Line: 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.On an average, 43% (95% CI: 40-46%) of women with ASCUS/ASC-US were high-risk HPV positive (range 23-74%).HPV rates dropped tremendously as age and cutoffs of test positivity increased.

View Article: PubMed Central - PubMed

Affiliation: Scientific Institute of Public Health, Brussels, Belgium. m.arbyn@iph.fgov.be

ABSTRACT
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.

Show MeSH

Related in: MedlinePlus

Meta-analysis of the proportion of women with ASCUS or a borderline Pap smear that have a positive Hybrid Capture II test.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3822872&req=5

fig01: Meta-analysis of the proportion of women with ASCUS or a borderline Pap smear that have a positive Hybrid Capture II test.

Mentions: We identified 32 studies enrolling all together 26,311 women with a cytological report of ASCUS, ASC-US or borderline dyskaryosis that could be included in the meta-analysis [13, 16, 36–65]. In 20 studies, high-risk HPV positivity could be derived for ASCUS defined according to TBS-1991, in six studies for AS-CUS, defined according to TBS-2001 and in six studies for borderline dyskaryosis, based on the BSCC terminology. The test-positivity rate varied between 22.8%[53] and 74.2%[55] (see Fig. 1). In spite of the wide and statistically significant inter-study heterogeneity, the pooled HPV positivity rates did not differ significantly by used cytological classification system (43.1% in ASCUS; 41.6% in ASC-US and 42.8% in borderline dyskaryosis; P for inter-group heterogeneity = 0.75). The overall pooled test positivity was 42.8% (95% CI: 39.5–46.1%).


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

Arbyn M, Martin-Hirsch P, Buntinx F, Van Ranst M, Paraskevaidis E, Dillner J - J. Cell. Mol. Med. (2009)

Meta-analysis of the proportion of women with ASCUS or a borderline Pap smear that have a positive Hybrid Capture II test.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3822872&req=5

fig01: Meta-analysis of the proportion of women with ASCUS or a borderline Pap smear that have a positive Hybrid Capture II test.
Mentions: We identified 32 studies enrolling all together 26,311 women with a cytological report of ASCUS, ASC-US or borderline dyskaryosis that could be included in the meta-analysis [13, 16, 36–65]. In 20 studies, high-risk HPV positivity could be derived for ASCUS defined according to TBS-1991, in six studies for AS-CUS, defined according to TBS-2001 and in six studies for borderline dyskaryosis, based on the BSCC terminology. The test-positivity rate varied between 22.8%[53] and 74.2%[55] (see Fig. 1). In spite of the wide and statistically significant inter-study heterogeneity, the pooled HPV positivity rates did not differ significantly by used cytological classification system (43.1% in ASCUS; 41.6% in ASC-US and 42.8% in borderline dyskaryosis; P for inter-group heterogeneity = 0.75). The overall pooled test positivity was 42.8% (95% CI: 39.5–46.1%).

Bottom Line: 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.On an average, 43% (95% CI: 40-46%) of women with ASCUS/ASC-US were high-risk HPV positive (range 23-74%).HPV rates dropped tremendously as age and cutoffs of test positivity increased.

View Article: PubMed Central - PubMed

Affiliation: Scientific Institute of Public Health, Brussels, Belgium. m.arbyn@iph.fgov.be

ABSTRACT
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.

Show MeSH
Related in: MedlinePlus