A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening

Abstract

Our objective was to assess the sensitivity and specificity of human papillomavirus (HPV) testing for cervical cancer screening in randomized trials. We conducted a systematic literature search of the following databases: MEDLINE, CINAHL, EMBASE, and Cochrane. Eligible studies were randomized trials comparing HPV-based to cytology-based screening strategies, with disease status determined by colposcopy/biopsy for participants with positive results. Disease rates (cervical intraepithelial neoplasia [CIN]2 or greater and CIN3 or greater), sensitivity, and positive predictive value were abstracted or calculated from the articles. Six studies met inclusion criteria. Relative sensitivities for detecting CIN3 or greater of HPV testing-based strategies vs cytology ranged from 0.8 to 2.1. The main limitation of our study was that testing methodologies and screening/management protocols were highly variable across studies. Screening strategies in which a single initial HPV-positive test led to colposcopy were more sensitive than cytology but resulted in higher colposcopy rates. These results have implications for cotesting with HPV and cytology as recommended in the United States.

FIGURE 1. Strategies for incorporating HPV testing into cervical cancer screening

Studies used different strategies for incorporating HPV testing into cervical cancer screening and for responding to positive HPV test results. HPV, human papillomavirus. *Refer to Table 1 for colposcopy thresholds for positive cytology results. Patanwala. HPV testing in cervical cancer screening. Am J Obstet Gynecol 2013.

FIGURE 2. Systematic review study selection process

Flow diagram of articles identified and excluded for the systematic review is shown. Patanwala. HPV testing in cervical cancer screening. Am J Obstet Gynecol 2013.

FIGURE 3. Number of colposcopies needed to detect 1 case of CIN2 or greater in round 1

Values are calculated as described in Materials and Methods. CIN, cervical intraepithelial neoplasia. Patanwala. HPV testing in cervical cancer screening. Am J Obstet Gynecol 2013.

FIGURE 4. Number of colposcopies needed to detect 1 case of CIN3 or greater in round 1

Values are calculated as described in Materials and Methods. CIN, cervical intraepithelial neoplasia. Patanwala. HPV testing in cervical cancer screening. Am J Obstet Gynecol 2013.