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Triage of ASC‐H : A meta‐analysis of the accuracy of high‐risk HPV testing and other markers to detect cervical precancer
Author(s) -
Xu Lan,
Verdoodt Freija,
Wentzensen Nicolas,
Bergeron Christine,
Arbyn Marc
Publication year - 2016
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.21661
Subject(s) - colposcopy , medicine , cervical intraepithelial neoplasia , triage , confidence interval , squamous intraepithelial lesion , obstetrics , gynecology , oncology , meta analysis , cervical cancer , cancer , emergency medicine
BACKGROUND Women with a cytological diagnosis of atypical squamous cells, cannot exclude high‐grade squamous intraepithelial lesion (ASC‐H) are usually immediately referred for colposcopy. However, triage may reduce the burden of the diagnostic workup and prevent overtreatment. METHODS A meta‐analysis was conducted to assess the accuracy of high‐risk human papillomavirus (hrHPV) testing and testing for other molecular markers for the detection of grade 2 cervical intraepithelial neoplasia or worse (CIN2+) or grade 3 cervical intraepithelial neoplasia or worse (CIN3+) in women with ASC‐H. An additional question that was assessed was whether triage would be useful in light of the relatively high pretriage probability of underlying precancer. RESULTS The pooled absolute sensitivity and specificity of the Hybrid Capture 2 (HC2) assay for CIN2 + (derived from 19 studies) were 93% (95% confidence interval [CI], 89%‐95%) and 45% (95% CI, 41%‐50%), respectively. p16 INK4a staining (only 3 studies) had similar sensitivity (93%; 95% CI, 75%‐100%) but superior specificity (specificity ratio, 1.69) to HC2 for CIN2+. Testing for paired box 1 gene methylation (only 1 study) showed a superior specificity of 95% (specificity ratio, 2.08). The average pretest risk was 34% for CIN2 + and 20% for CIN3+. A negative HC2 result decreased this to 8% and 5%, respectively, whereas a positive result upgraded the risk to 47% and 28%, respectively. CONCLUSIONS Because of the high probability of precancer with a diagnosis of ASC‐H, the utility of triage is limited. The usual recommendation for referring women with ASC‐H for colposcopy is not altered by a positive triage test, whatever test is used. A negative hrHPV DNA or p16 INK4a test may allow repeat testing, but this recommendation will depend on local decision thresholds for referral. Cancer Cytopathol 2016;124:261–72 . © 2015 American Cancer Society .