Original Research ReportClinical utility of HPV–DNA detection: Triage of minor cervical lesions, follow-up of women treated for high-grade CIN: An update of pooled evidence
Introduction
The purpose of this study was to explore emerging directions in the prevention of cervical cancer by comparing efficacy and accuracy of new and conventional methods. The recognition of the strong causal relationship between persistent infection of the genital tract with high-risk human papilloma virus types and the occurrence of cervical cancer [1], [2] has resulted in experimental and industrial development of HPV detection systems. Detection of high-risk HPV–DNA is considered to be potentially useful in three clinical applications: first as a primary screening test, solely or in combination with a Pap smear to detect cervical cancer precursors; second as a triage test to select women showing minor cytological lesions in their Pap smears who need referral for diagnosis and treatment; and third as a follow-up test for women who have been treated for high-grade intra-epithelial lesion with local ablative or excisional therapy to predict cure or failure of treatment [3].
In two recent reviews, we synthesized available knowledge concerning the performance of HPV–DNA testing relative to cytological smears. This was done for the last two indications derived from reports published until 2002 [4], [5], [6], [7]. These projects guided our current efforts. Because of the emerging nature of research in this area, it is necessary to constantly update our understanding of current progress. In the present review, we extend the previous meta-analyses by appending new studies reported since the last 2 years.
Section snippets
Materials and methods
A systematic review combines similar studies in one particular area of research. By pooling together all of the studies, researchers can examine a much larger sample of relevant data. In certain conditions, a meta-analysis can produce a numerical figure from the systematic review, which is an estimate of the overall pooled outcome measure.
The first review targeted studies where women showed equivocal or low-grade cytological lesions. Patients in these studies were followed with the high-risk
Triage of women with atypical squamous cells
The accuracy of HPV triage using hybrid capture™ (HC2) observed in each of 16 retrieved studies [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] that matched our selection criteria is shown in Table 1. The sensitivity and specificity of HC2, pooled over all the studies, was 94% (95% CI [CI]: 92–96%) and 62% (CI: 56–68%), respectively. The sensitivity of HC2 was 14% (CI: 8–20%) higher than repeat cytology, in six studies where both triage methods were
Conclusions
The HC2 performs better than repeat cytology as triage method for women with equivocal Pap smear results, but not in case of low-grade cytological lesions. HPV–DNA detection potentially can shorten follow-up after treatment of CIN, given its higher sensitivity in predicting treatment failure.
Acknowledgments
These reviews were funded by the European Commission, within the framework of the European Cancer Network, and by the Gynaecological Cancer Cochrane Review Collaboration. This paper reflects the contents of an invited presentation at the 4th International Conference on Cervical Cancer, organised by the MD Anderson Cancer Institute, Houston, University of Texas, USA, 19–21 May, 2005. We acknowledge Alice Lytwyn, Robert Pretorius and Shalini Kulasingam for the provision of additional data
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