Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate

摘要

Consistent evidence underlines the utility of human papillomavirus (HPV) DNA testing in the management of women with equivocalcervical cytological abnormalities, but not in case of low-grade lesions. We performed a meta-analysis including studies where thehigh-risk probe of the Hybrid Capture-II is used to triage these two cytological categories. The triage test-positivity rate reflects thecolposcopy referral workload.Data were pooled on the HPV test positivity rate in women with atypical squamous cells of undeterminedsignificance (ASCUS/ASC-US) or low-grade squamous intraepithelial lesions (LSIL), derived from different cytological classificationsystems. The meta-analysis was restricted to studies, published between 1991 and 2007. A random-effect model was applied for metaanalyticalpooling and the influence of covariates on the HPV positivity rate was analyzed by meta-regression. The variation by age wasassessed within individual studies since age strata were not defined uniformly. On an average, 43% (95% CI: 40–46%) of women withASCUS/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 triagegroups was large and highly significant: 32% (95% CI: 27–38%). HPV rates dropped tremendously as age and cutoffs of testpositivity increased. Other factors (cytological classification system, country, continent, collection method and year of publication) hadno statistically significant impact, except in LSIL triage where HPV positivity was significantly lower in European compared to Americanstudies. Women with LSIL, especially younger women, have high HPV positivity rates suggesting limited utility of reflex HPV triagingthese cases. Research is needed to identify more specific methods to triage women with low-grade squamous cervical lesions.