Diagnostic Accuracy of Human Papillomavirus Test for Cervical Neoplasia: A Systematic Review of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

LI Kemin ¹ ,  YIN Rutie ¹ , KANG Deying ² , WU Weiwei ³ , WEN Jin ²

1. Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China;2. Chinese Evidence-Based Medicine Center, Sichuan University, Chengdu 610041, China;3. Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

YIN Rutie, Email: yinrutie2008@yahoo.cn

Keywords：

Cervical dysplasia; Human papillomavirus (HPV); Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20110154

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the diagnostic accuracy of human papillomavirus test for cervical neoplasia.
Methods　 The Cochrane Library (Issue 2, 2010), Cochrane Central Register of Controlled Trials (Issue 2, 2010), and the following databases as CBMdisc, CNKI, MEDLINE, PubMed, and EMbase were all searched from their establishment to June 2010 to get all the randomized control trials (RCTs), and the relevant magazines and the references of the included studies were also searched. The screening, data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently. The software Metadisc 1.4 was used to perform meta-analyses, and the forest plots and SROC curves were drewn with the RevMan 5.0 software.
Results 　A total of 7 RCTs involving 171 604 subjects were included. The meta-analyses showed, the sensitivity of the HPV test for detecting cervical neoplasia (CIN) was higher than that of the conventional cytology test; the difference in sensitivity for detecting CIN in or above second grade was only found between the test of HPV combined with cervical cytology and the test of conventional cytology (P lt;0.00001), but the HPV test obviously lowered its diagnostic specificity. Among the following three tests for diagnosing CIN, such as, the single test of HPV, the combined test of HPV and cervical cytology, and the test of HPV followed by cytology shunting, the statistic differences compared with the conventional cytology test were found (P lt;0.01) except the last test (P=0.41) which had no difference in diagnosing CIN in or above the first grade.
Conclusion 　The current evidence indicates that, compared with the conventional cytology test, the HPV combined with the cytology test can improve the sensitivity for diagnosing CIN in or above the second grade, but the HPV test cannot improve the specificity for cervical neoplasia. The application of human papillomavirus test for detecting cervical neoplasia needs to be further studied.

Citation： LI Kemin,YIN Rutie,KANG Deying,WU Weiwei,WEN Jin. Diagnostic Accuracy of Human Papillomavirus Test for Cervical Neoplasia: A Systematic Review of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2011, 11(8): 910-918. doi: 10.7507/1672-2531.20110154 Copy

1.	1 Reeves WC, Quiroz E. Prevalence of sexually transmitted diseases in high-risk women in the Republic of Panama. Sex Transm Dis , 1987, 14(2): 69-74.
2.	Morrison EA, Ho GY, Vermund SH, et al . Human papillomavirus infection and other risk factors for cervical neoplasia: case-control study. Int J Cancer , 1991, 49(1): 6-13.
3.	Bosch FX, Muñoz N, de Sanjosé S, et al . Risk factors for cervical cancer in Colombia and Spain. Int J Cance r, 1992, 52(5): 750-758.
4.	Bosch FX, Manos MM, Muñoz N, et al . Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst , 1995, 87(11): 796-802.
5.	Yamakawa Y, Forslund O, Teshima H, et al . Human papillomavirus DNA in adenocarcinoma and adenosquamous carcinoma of the uterine cervix detected by polymerase chain reaction (PCR). Gynecol Oncol , 1994, 53(2): 190-195.
6.	Blumenthal PD, Gaffikin L, Chirenje ZM, et al . Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear. Int J Gynaecol Obstet , 2001, 72(1): 47-53.
7.	Costa S, SideriM, Syrjanen K, et al . Combined Pap smear, cervicography and HPV DNA testing in the detection of cervical intraepithelial neoplasia and cancer. Acta Cytol , 2000, 44(3): 310-318.
8.	Cuzick J, Szarewski A, Terry G, et al . Human papillomavirus testing in primary cervical screening. Lancet , 1995, 345(8964): 1533-1536.
9.	Sherman ME, Lorincz AT, Scott DR, et al . Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a 10-year cohort analysis. J Natl Cancer Inst , 2003, 95(1), 46-52.
10.	Wu D, Ding L, Wu JH, et al . Application of liquid-based cytology and high-risk human papillomavirus DNA detection in cervical lesion screening. J South Med Nniv , 2007, 27(9): 1421-1423.
11.	Arbyn M, Buntinx F, Van Ranst M, et al . Cytologic versus virologic triage of women with equivocal Pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst , 2004, 96(4): 280-293.
12.	Solomon D, Schiffman M. Have we resolved how to triage equivocal cervical cytology? J Natl Cancer Inst , 2004, 96(4): 250-251.
13.	Paraskevaidis E, Arbyn M, Sotiriadis A, et al . The role of HPV testing in the follow up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev , 2004, 30(2): 205-211.
14.	Arbyn M, Paraskevaidis E, Martin-Hirsch P, et al . Clinical utility of HPV DNA detection: triage of minor cervical lesions, follow-up of women treated for high-grade CIN. An update of pooled evidence. Gynecol Oncol , 2005, 99(Suppl 3): 7-11.
15.	Solomon D, Davey D, Kurman R, et al . The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA , 2002, 287(16): 2114-2119.
16.	Richart RM. Cervical intraepithelial neoplasia. Pathol Annu , 1973, 8: 301-328.
17.	de Vet HCW, Eisinga A, Riphagen II, et al . Searching for studies//Deeks JJ, Bossuyt PM, Gatsonis C. Cochrane Handbook for Diagnostic Test Accuracy Version 1.0.0. The Cochrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
18.	Smidt N, Deeks J, Moore T. Guide to the contents of a Cochrane review and protocol for Diagnostic Test Accuracy version 1.0.1 (updated February 2008). The Conchrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
19.	Whiting P, Rutjes AW, Reitsma JB, et al . The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003. Available from: URL: http://www.biomedcentral.com/1471-2288/3/25.
20.	Whiting PF, Weswood ME, Rutjes AW, et al . Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 2006. Available from: URL: http://www.biomedcentral.com/1471-2288/6/9.
21.	Cochran WG. The combination of estimates from different experiments. Biometrics , 1954, 10(6): 101-129.
22.	Higgins JP, Thompson SG, Deeks JJ, et al . Measuring inconsistency in meta-analyses. BMJ , 2003, 327(7414): 557-560.
23.	Lytwyn A, Sellors JW, Mahony JB, et al . Comparison of human papillomavirus DNA testing and repeat Papanicolaou test in women with low-grade cervical cytologic abnormalities: a randomized trial. CMAJ , 2000, 163(6): 701-707.
24.	Lytwyn A, Sellors JW, Mahony JB, et al . Adjunctive human papillomavirus testing in the 2-year follow-up of women with low-grade cervical cytologic abnormalities: a randomized trial and economic evaluation. Arch Pathol Lab Med , 2003, 127(9): 1169-1175.
25.	Sankaranarayanan R, Nene BM, Dinshaw KA, et al . A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer , 2005, 116(4): 617-623.
26.	Kotaniemi-Talonen L, Nieminen P, Anttila1 A, et al . Cervical screening with primary HPV testing and cytology triage protocol in a randomized setting. British Journal of Cancer , 2005, 93(8): 862-867.
27.	Kotaniemi-Talonen L, Anttila A, Malila N, et al . Screening with a primary human papillomavirus test does not increase detection of cervical cancer and intraepithelial neoplasia 3. Eur J Cancer , 2008, 44(4): 565-571.
28.	Ronco G, Giorgi-Rossi P, Carozzi F, et al . Results at recruitment from a randomized controlled trial comparing human papillomavirus testing alone with conventional cytology as the primary cervical cancer screening test. J Natl Cancer Inst , 2008, 100(7): 492-501.
29.	Bjerre P, Silfverdal L, Dillner L, et al . A randomized trial of basing treatment on human papillomavirus and/or cytology results in low-grade cervical lesion triage. Am J Obstet Gynecol , 2008, 199(1): 24.e1-7.
30.	Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: results of the recruitment phase of a large randomised controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
31.	Ronco G, Segnan N, Giorgi-Rossi P, 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 , 2006, 98(11): 765-774.
32.	Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: results of the recruitment phase of a large randomized controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
33.	Disaia PJ, Creasman WT. Preinvasive disease of the cervix. Disaia PJCreasman WT editor. Clinical gynecologic oncology. 6th ed. Health Science Asia, Elsevier Science, 2002: 1-33.
34.	Edward E, Abu-Rustum N, Susan M, et al . Cervical Cancer Screening. V.1.2010. NCCN Clinical Practice Guidelines in Oncology. Available from: URL: http://www.nccn.org.
35.	Kitchener HC, Almonte M, Thomson C. HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomized controlled trial. Lancet Oncol , 2009, 10(7): 672-682.
36.	Kitchener HC, Almonte M, Gilham C. ARTISTIC: a randomised trial of human papillomavirus (HPV)testing in primary cervical screening. Health Technol Assess , 2009, 13(51): 1-150, iii-iv.

1. 1 Reeves WC, Quiroz E. Prevalence of sexually transmitted diseases in high-risk women in the Republic of Panama. Sex Transm Dis , 1987, 14(2): 69-74.
2. Morrison EA, Ho GY, Vermund SH, et al . Human papillomavirus infection and other risk factors for cervical neoplasia: case-control study. Int J Cancer , 1991, 49(1): 6-13.
3. Bosch FX, Muñoz N, de Sanjosé S, et al . Risk factors for cervical cancer in Colombia and Spain. Int J Cance r, 1992, 52(5): 750-758.
4. Bosch FX, Manos MM, Muñoz N, et al . Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst , 1995, 87(11): 796-802.
5. Yamakawa Y, Forslund O, Teshima H, et al . Human papillomavirus DNA in adenocarcinoma and adenosquamous carcinoma of the uterine cervix detected by polymerase chain reaction (PCR). Gynecol Oncol , 1994, 53(2): 190-195.
6. Blumenthal PD, Gaffikin L, Chirenje ZM, et al . Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear. Int J Gynaecol Obstet , 2001, 72(1): 47-53.
7. Costa S, SideriM, Syrjanen K, et al . Combined Pap smear, cervicography and HPV DNA testing in the detection of cervical intraepithelial neoplasia and cancer. Acta Cytol , 2000, 44(3): 310-318.
8. Cuzick J, Szarewski A, Terry G, et al . Human papillomavirus testing in primary cervical screening. Lancet , 1995, 345(8964): 1533-1536.
9. Sherman ME, Lorincz AT, Scott DR, et al . Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a 10-year cohort analysis. J Natl Cancer Inst , 2003, 95(1), 46-52.
10. Wu D, Ding L, Wu JH, et al . Application of liquid-based cytology and high-risk human papillomavirus DNA detection in cervical lesion screening. J South Med Nniv , 2007, 27(9): 1421-1423.
11. Arbyn M, Buntinx F, Van Ranst M, et al . Cytologic versus virologic triage of women with equivocal Pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst , 2004, 96(4): 280-293.
12. Solomon D, Schiffman M. Have we resolved how to triage equivocal cervical cytology? J Natl Cancer Inst , 2004, 96(4): 250-251.
13. Paraskevaidis E, Arbyn M, Sotiriadis A, et al . The role of HPV testing in the follow up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev , 2004, 30(2): 205-211.
14. Arbyn M, Paraskevaidis E, Martin-Hirsch P, et al . Clinical utility of HPV DNA detection: triage of minor cervical lesions, follow-up of women treated for high-grade CIN. An update of pooled evidence. Gynecol Oncol , 2005, 99(Suppl 3): 7-11.
15. Solomon D, Davey D, Kurman R, et al . The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA , 2002, 287(16): 2114-2119.
16. Richart RM. Cervical intraepithelial neoplasia. Pathol Annu , 1973, 8: 301-328.
17. de Vet HCW, Eisinga A, Riphagen II, et al . Searching for studies//Deeks JJ, Bossuyt PM, Gatsonis C. Cochrane Handbook for Diagnostic Test Accuracy Version 1.0.0. The Cochrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
18. Smidt N, Deeks J, Moore T. Guide to the contents of a Cochrane review and protocol for Diagnostic Test Accuracy version 1.0.1 (updated February 2008). The Conchrane Collaboration 2008. Available from: URL: http://srdta.cochrane.org.
19. Whiting P, Rutjes AW, Reitsma JB, et al . The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003. Available from: URL: http://www.biomedcentral.com/1471-2288/3/25.
20. Whiting PF, Weswood ME, Rutjes AW, et al . Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 2006. Available from: URL: http://www.biomedcentral.com/1471-2288/6/9.
21. Cochran WG. The combination of estimates from different experiments. Biometrics , 1954, 10(6): 101-129.
22. Higgins JP, Thompson SG, Deeks JJ, et al . Measuring inconsistency in meta-analyses. BMJ , 2003, 327(7414): 557-560.
23. Lytwyn A, Sellors JW, Mahony JB, et al . Comparison of human papillomavirus DNA testing and repeat Papanicolaou test in women with low-grade cervical cytologic abnormalities: a randomized trial. CMAJ , 2000, 163(6): 701-707.
24. Lytwyn A, Sellors JW, Mahony JB, et al . Adjunctive human papillomavirus testing in the 2-year follow-up of women with low-grade cervical cytologic abnormalities: a randomized trial and economic evaluation. Arch Pathol Lab Med , 2003, 127(9): 1169-1175.
25. Sankaranarayanan R, Nene BM, Dinshaw KA, et al . A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer , 2005, 116(4): 617-623.
26. Kotaniemi-Talonen L, Nieminen P, Anttila1 A, et al . Cervical screening with primary HPV testing and cytology triage protocol in a randomized setting. British Journal of Cancer , 2005, 93(8): 862-867.
27. Kotaniemi-Talonen L, Anttila A, Malila N, et al . Screening with a primary human papillomavirus test does not increase detection of cervical cancer and intraepithelial neoplasia 3. Eur J Cancer , 2008, 44(4): 565-571.
28. Ronco G, Giorgi-Rossi P, Carozzi F, et al . Results at recruitment from a randomized controlled trial comparing human papillomavirus testing alone with conventional cytology as the primary cervical cancer screening test. J Natl Cancer Inst , 2008, 100(7): 492-501.
29. Bjerre P, Silfverdal L, Dillner L, et al . A randomized trial of basing treatment on human papillomavirus and/or cytology results in low-grade cervical lesion triage. Am J Obstet Gynecol , 2008, 199(1): 24.e1-7.
30. Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: results of the recruitment phase of a large randomised controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
31. Ronco G, Segnan N, Giorgi-Rossi P, 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 , 2006, 98(11): 765-774.
32. Giorgi-Rossi P, Segnan N, Zappa M, et al . The impact of new technologies in cervical cancer screening: results of the recruitment phase of a large randomized controlled trial from a public health perspective. Int J Cancer , 2007, 121(12): 2729-2734.
33. Disaia PJ, Creasman WT. Preinvasive disease of the cervix. Disaia PJCreasman WT editor. Clinical gynecologic oncology. 6th ed. Health Science Asia, Elsevier Science, 2002: 1-33.
34. Edward E, Abu-Rustum N, Susan M, et al . Cervical Cancer Screening. V.1.2010. NCCN Clinical Practice Guidelines in Oncology. Available from: URL: http://www.nccn.org.
35. Kitchener HC, Almonte M, Thomson C. HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomized controlled trial. Lancet Oncol , 2009, 10(7): 672-682.
36. Kitchener HC, Almonte M, Gilham C. ARTISTIC: a randomised trial of human papillomavirus (HPV)testing in primary cervical screening. Health Technol Assess , 2009, 13(51): 1-150, iii-iv.

Previous Article
Patients for Patient Safety: A Systematic Review
Next Article
Indirect Comparison of Tongxinluo Capsule and Danshen Dripping Pill for Angina Pectoris: A Systematic Review

Chinese Journal of Evidence-Based Medicine

Diagnostic Accuracy of Human Papillomavirus Test for Cervical Neoplasia: A Systematic Review of Randomized Controlled Trials

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content