High-risk human papillomavirus testing versus cytology in predicting post-treatment disease in women treated for high-grade cervical disease: A systematic review and meta-analysis

ObjectiveCurrently, women treated for high-grade cervical intraepithelial neoplasia (CIN 2/3) are followed-up by cytology to monitor them for residual and recurrent (post-treatment) disease. This systematic review and meta-analysis determine the test performance of testing for high-risk types of the human papillomavirus (hrHPV), cytology and co-testing (combined hrHPV testing and cytology) in predicting high-grade post-treatment disease (CIN2+).MethodsStudies that compared at least two of three post-treatment surveillance methods, and were published between January 2003 and May 2011, were identified through a bibliographic database search (PubMed, Embase.com and Wiley/Cochrane Library). Identification of relevant studies was conducted independently by two reviewers with a multi-step process. The reference standard used to diagnose post-treatment disease was histologically confirmed CIN2+.Sensitivity, specificity, diagnostic odds ratios and relative sensitivity and specificity were calculated for each study. Pooled estimates were calculated using a random effects model if heterogeneity among studies was significant, otherwise by using a fixed effects model. Estimates were reported with 95% confidence intervals (95%CI).ResultsOut of 2410 potentially relevant citations, 8 publications, incorporating 1513 treated women, were included. Pooled sensitivities were 0.79 (95%CI 0.72–0.85) for cytology, 0.92 (0.87–0.96) for hrHPV testing, and 0.95 (0.91–0.98) for co-testing. HrHPV testing was more sensitive than cytology to predict post-treatment CIN2+ (relative sensitivity 1.15; 95%CI 1.06–1.25). Pooled specificities were 0.81 (95%CI 0.74–0.86) for cytology, 0.76 (0.67–0.84) for hrHPV testing and 0.67 (0.60–0.74) for co-testing. HrHPV testing and cytology had a similar specificity (relative specificity 0.95, 95%CI 0.88–1.02).ConclusionsThis review indicates that the hrHPV test should be included in post-treatment testing 6 months after treatment, because hrHPV testing has a higher sensitivity than cytology in detecting high-grade post-treatment disease and has a similar specificity.

► Women treated for CIN2/3 are followed-up to monitor them for residual and recurrent (post-treatment) disease.
► HrHPV testing has a higher sensitivity than, and a similar specificity to cytology to detect high-grade post-treatment disease.
► HrHPV testing at 6 months after treatment should be incorporated in the surveillance of treated women.