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p16INK4a immunocytochemistry versus human papillomavirus testing for triage of women with minor cytologic abnormalities †‡
A systematic review and meta-analysis
Article first published online: 14 JUN 2012
Copyright © 2012 American Cancer Society
Volume 120, Issue 5, pages 294–307, 25 October 2012
How to Cite
Roelens, J., Reuschenbach, M., von Knebel Doeberitz, M., Wentzensen, N., Bergeron, C. and Arbyn, M. (2012), p16INK4a immunocytochemistry versus human papillomavirus testing for triage of women with minor cytologic abnormalities . Cancer Cytopathology, 120: 294–307. doi: 10.1002/cncy.21205
The authors acknowledge M. Nasioutziki, M. Guo, A. Szarewski, J. Cuzick and J. Monsonego for the provision of additional data as well as L. Houthuys for bibliographic support.
See related Commentary on pages 291–293, this issue.
- Issue published online: 12 OCT 2012
- Article first published online: 14 JUN 2012
- Manuscript Accepted: 1 FEB 2012
- Manuscript Revised: 25 JAN 2012
- Manuscript Received: 6 DEC 2011
- cervical cancer;
- cervical intraepithelial neoplasia;
- atypical squamous cells of undetermined significance;
- low-grade squamous intraepithelial lesions;
- human papillomavirus testing;
- diagnostic accuracy;
- systematic review
The best method for identifying women who have minor cervical lesions that require diagnostic workup remains unclear. The authors of this report performed a meta-analysis to assess the accuracy of cyclin-dependent kinase inhibitor 2A (p16INK4a) immunocytochemistry compared with high-risk human papillomavirus DNA testing with Hybrid Capture 2 (HC2) to detect grade 2 or greater cervical intraepithelial neoplasia (CIN2+) and CIN3+ among women who had cervical cytology indicating atypical squamous cells of undetermined significance (ASC-US) or low-grade cervical lesions (LSIL). A literature search was performed in 3 electronic databases to identify studies that were eligible for this meta-analysis. Seventeen studies were included in the meta-analysis. The pooled sensitivity of p16INK4a to detect CIN2+ was 83.2% (95% confidence interval [CI], 76.8%-88.2%) and 83.8% (95% CI, 73.5%-90.6%) in ASC-US and LSIL cervical cytology, respectively, and the pooled specificities were 71% (95% CI, 65%-76.4%) and 65.7% (95% CI, 54.2%-75.6%), respectively. Eight studies provided both HC2 and p16INK4a triage data. p16INK4a and HC2 had similar sensitivity, and p16INK4a has significantly higher specificity in the triage of women with ASC-US (relative sensitivity, 0.95 [95% CI, 0.89-1.01]; relative specificity, 1.82 [95% CI, 1.57-2.12]). In the triage of LSIL, p16INK4a had significantly lower sensitivity but higher specificity compared with HC2 (relative sensitivity, 0.87 [95% CI, 0.81-0.94]; relative specificity, 2.74 [95% CI, 1.99-3.76]). The published literature indicated the improved accuracy of p16INK4a compared with HC2 testing in the triage of women with ASC-US. In LSIL triage, p16INK4a was more specific but less sensitive. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.