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Title: Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate
Authors: Arbyn, Marc * ×
Martin-Hirsch, Pierre *
Buntinx, Frank *
Van Ranst, Marc *
Paraskevaidis, Evangelos *
Dillner, Joakim * #
Issue Date: 2009
Publisher: Wiley-Blackwell Publishing Ltd.
Series Title: Journal of Cellular and Molecular Medicine vol:13 issue:4 pages:648-659
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 metaanalytical
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.
ISSN: 1582-4934
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Academic Center for General Practice
Laboratory of Clinical and Epidemiological Virology (Rega Institute)
* (joint) first author
× corresponding author
# (joint) last author

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