Li Tong, Li Yan, Yang Guo-Xian, Shi Peng, Sun Xiao-Ying, Yang Yu, Li Ying-Ying, Liu Yang
Department of Gynecology and Obstetrics, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China.
J Cancer Res Ther. 2016 Jan-Mar;12(1):283-9. doi: 10.4103/0973-1482.154032.
The objective of this study was to assess the diagnostic value of combination of human papillomavirus (HPV) testing and cytology as compared to isolated cytology in screening cervical cancer.
We searched public databases including PubMed and Embase before September 30, 2014. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) of the two methods from included studies were meta-analyzed. The summary receiver operating characteristic (SROC) curve was constructed, and the area under curve (AUC) and an index Q* were summarized. Besides, a two-sample Z-test was conducted to evaluate the differences of the two diagnostic modalities.
Totally eight studies were involved. The included studies showed significant heterogeneity in estimating sensitivity, specificity, positive LR, negative LR, and DOR in both methods. The results of the above indexes in combination method were 0.937 (95% confidence interval (CI): 0.925-0.948), 0.858 (95% CI: 0.855-0.860), 3.924 (95% CI: 2.037-7.559), 0.083 (95% CI: 0.033-0.210), and 51.563 (95% CI: 14.682-181.09), respectively. The AUC and Q* index were 0.8841 and 0.8763, respectively. The results for isolated method were 0.743 (95% CI: 0.716-0.768), 0.951 (95% CI: 0.949-0.953), 6.408 (95% CI: 2.322-17.683), 0.226 (95% CI: 0.112-0.460), and 30.897 (95% CI: 7.170-133.15), respectively. The AUC and Q* index were 0.8550 and 0.7859, respectively. Combination method was superior to isolated method (Z = 13.375, P < 0.01) in sensitivity, while was inferior to isolated method (Z = 56.935, P < 0.01) in specificity.
Combination of HPV testing and cytology may be appropriate for screening cervical cancer if conditions allow.
本研究的目的是评估人乳头瘤病毒（HPV）检测与细胞学检查相结合相比于单纯细胞学检查在宫颈癌筛查中的诊断价值。
我们检索了截至2014年9月30日的包括PubMed和Embase在内的公共数据库。对纳入研究中两种方法的敏感性、特异性、阳性似然比（LR）、阴性LR和诊断比值比（DOR）进行了荟萃分析。构建了汇总的受试者工作特征（SROC）曲线，并总结了曲线下面积（AUC）和指数Q*。此外，进行了双样本Z检验以评估两种诊断方式的差异。
共纳入八项研究。纳入的研究在估计两种方法的敏感性、特异性、阳性LR、阴性LR和DOR方面显示出显著的异质性。联合方法上述指标的结果分别为0.937（95%置信区间（CI）：0.925 - 0.948）、0.858（95%CI：0.855 - 0.860）、3.924（95%CI：2.037 - 7.559）、0.083（95%CI：0.033 - 0.210）和51.563（95%CI：14.682 - 181.09）。AUC和Q指数分别为0.8841和0.8763。单纯方法的结果分别为0.743（95%CI：0.716 - 0.768）、0.951（95%CI：0.949 - 0.953）、6.408（95%CI：2.322 - 17.683）、0.226（95%CI：0.112 - 0.460）和30.897（95%CI：7.170 - 133.15）。AUC和Q指数分别为0.8550和0.7859。联合方法在敏感性方面优于单纯方法（Z = 13.375，P < 0.01），而在特异性方面低于单纯方法（Z = 56.935，P < 0.01）。
如果条件允许，HPV检测与细胞学检查相结合可能适用于宫颈癌筛查。
