We acknowledge S. Andersson, E. Andersson, and S. Ratnam for the provision of additional data.
Triage of women with minor abnormal cervical cytology: Meta-analysis of the accuracy of an assay targeting messenger ribonucleic acid of 5 high-risk human papillomavirus types
Article first published online: 23 JUL 2013
© 2013 American Cancer Society
Volume 121, Issue 12, pages 675–687, December 2013
How to Cite
Verdoodt, F., Szarewski, A., Halfon, P., Cuschieri, K. and Arbyn, M. (2013), Triage of women with minor abnormal cervical cytology: Meta-analysis of the accuracy of an assay targeting messenger ribonucleic acid of 5 high-risk human papillomavirus types. Cancer Cytopathology, 121: 675–687. doi: 10.1002/cncy.21325
- Issue published online: 13 DEC 2013
- Article first published online: 23 JUL 2013
- Manuscript Revised: 3 MAY 2013
- Manuscript Accepted: 3 MAY 2013
- Manuscript Received: 4 APR 2013
- cervical cancer;
- cervical intraepithelial neoplasia;
- atypical squamous cells of undetermined significance;
- low-grade squamous intraepithelial lesions;
- messenger RNA;
- human papillomavirus testing;
- diagnostic accuracy
High-risk human papillomavirus (hrHPV) DNA detection is generally accepted for the triage of women with a cytologic diagnosis of atypical squamous cells of undetermined significance (ASC-US). However, no consensus has been reached on the optimal management of low-grade squamous intraepithelial lesions (LSIL).
In this meta-analysis, the diagnostic accuracy of nucleic acid sequence-based amplification (NASBA) detection of messenger ribonucleic acid (mRNA) of 5 hrHPV types (the PreTect HPV-Proofer and NucliSENS EasyQ tests) for detecting grade 2 cervical intraepithelial neoplasia or worse (CIN2+) and CIN3+ was assessed in women who had a diagnosis of ASC-US and LSIL. The results were compared with the Hybrid Capture-2 (HC2) assay, which detects the DNA of 13 hrHPV types. A bivariate random-effect model that incorporated the intrinsic correlation between the true-positive and false-positive rates was used for a pooled meta-analysis.
Considering underlying CIN2+, the pooled absolute sensitivity of the 10 included studies was 75.4% (95% confidence interval [CI], 68.1%-82.7%) and 76.2% (95% CI, 68.3%-76.9%) for the triage of ASC-US and LSIL, respectively. The pooled absolute specificity to exclude CIN2+ was 77.9% (95% CI, 70.1%-85.7%) and 74.2% (95% CI, 69.5%-78.8%) in women with ASC-US and LSIL, respectively. Five studies allowed direct comparison of the mRNA assays with HC2. Considering CIN2+ in women with ASC-US and LSIL, mRNA testing was substantially more specific than the HC2 assay (ratio: 1.98 and 3.36, respectively; P < .001) but was less sensitive (ratio: 0.80 and 0.74, respectively; P < .001).
HPV assays for detecting the mRNA of 5 hrHPV types may reduce the over-diagnosis of women who have minor cytologic abnormalities. However, given the lower sensitivity, women with negative mRNA test results cannot be considered free of CIN2+ and require further surveillance. Cancer (Cancer Cytopathol) 2013;121:675–687. © 2013 American Cancer Society.