Koliopoulos George, Arbyn Marc, Martin-Hirsch Pierre, Kyrgiou Maria, Prendiville Walter, Paraskevaidis Evangelos
Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
Gynecol Oncol. 2007 Jan;104(1):232-46. doi: 10.1016/j.ygyno.2006.08.053. Epub 2006 Nov 3.
This is a meta-analysis of studies comparing HPV testing to cytology with regard to their accuracy in the detection of underlying high grade cervical intraepithelial neoplasia in primary cervical cancer screening.
A systematic review was conducted following the Cochrane Collaboration Guidelines. A systematic search was performed in 8 electronic databases. Strict selection criteria were applied in terms of types of participants, types of interventions and methods to limit verification bias. Where possible we calculated the sensitivity, specificity, positive and negative predictive value of cytology and the HPV test, as well as sensitivity and specificity ratios for the detection of CIN2 or worse. Random effect models were used for pooling accuracy parameters. The results were displayed using forest plots.
We identified 25 studies fulfilling the inclusion criteria. The pooled sensitivity of HC2, PCR, cytology (ASCUS or worse) and cytology (LSIL or worse) was 90%, 80.9%, 72.7% and 61.6%, respectively, and the pooled specificity was 86.5%, 94.7%, 91.9% and 96.0%, respectively. The ratio of the sensitivity of HC2 to cytology (ASCUS) was 1.25 (95% CI=1.20-1.29), and the corresponding specificity ratio was 0.97 (95% CI=0.96-0.98). The ratio of the sensitivity of combination of HC2 and cytology (ASCUS) to HC2 alone was 1.05 (95% CI=1.04-1.06) and the ratio of the specificity 0.95 (95% CI=0.94-0.96). For women over 30 years, the sensitivity of HC2 was 94.8% and the specificity 86.0%.
Compared to cytology, the HC2 and PCR are substantially more sensitive for prevalent CIN2 or worse but significantly less specific. The combination of HC2 and cytology has the highest sensitivity and lowest specificity. However, reduction of the incidence of or mortality from invasive cervical cancer among HPV screened subjects compared to cytologically screened subjects has not yet been demonstrated.
本研究为一项荟萃分析，比较了在原发性宫颈癌筛查中，HPV检测与细胞学检查在检测潜在高级别宫颈上皮内瘤变方面的准确性。
按照Cochrane协作网指南进行系统评价。在8个电子数据库中进行系统检索。在参与者类型、干预措施类型和限制验证偏倚的方法方面应用了严格的选择标准。尽可能计算了细胞学检查和HPV检测的灵敏度、特异度、阳性预测值和阴性预测值，以及检测CIN2或更严重病变的灵敏度和特异度比值。采用随机效应模型汇总准确性参数。结果用森林图展示。
我们确定了25项符合纳入标准的研究。HC2、PCR、细胞学检查（不典型鳞状细胞或更严重病变）和细胞学检查（低度鳞状上皮内病变或更严重病变）的合并灵敏度分别为90%、80.9%、72.7%和61.6%，合并特异度分别为86.5%、94.7%、91.9%和96.0%。HC2与细胞学检查（不典型鳞状细胞）的灵敏度比值为1.25（95%CI = 1.20 - 1.29），相应的特异度比值为0.97（95%CI = 0.96 - 0.98）。HC2与细胞学检查（不典型鳞状细胞）联合检测与单独HC2检测的灵敏度比值为1.05（95%CI = 1.04 - 1.06），特异度比值为0.95（95%CI = 0.94 - 0.96）。对于30岁以上女性，HC2的灵敏度为94.8%，特异度为86.0%。
与细胞学检查相比，HC2和PCR对常见CIN2或更严重病变的灵敏度显著更高，但特异度显著更低。HC2与细胞学检查联合检测具有最高的灵敏度和最低的特异度。然而，与细胞学筛查受试者相比，HPV筛查受试者中浸润性宫颈癌的发病率或死亡率降低尚未得到证实。
