HPV Triage for Cervical Cytology Abnormalities

Arbyn et al. [17 (link)] assessed the HPV test positivity rate in women with equivocal or low-grade cervical cytological abnormalities. HPV testing has been proposed as a method to triage women with minor cytological abnormalities identified through screening for cervical cancer using the Pap smear [19 (link), 20 ]. The prevalence of HPV infection reflects the burden of referral and diagnostic work-up when the test is used to triage women with these cytological conditions [17 (link)]. Two groups of minor cytological abnormalties can be distinguished: a) atypical squamous cells of undetermined significance (ASC-US) or borderline dyskaryosis and b) low-grade squamous intraepithelial lesion (LSIL) or mild dyskaryosis. The meta-analysis concluded that the large majority of women with LSIL were infected with HPV suggesting limited utility of HPV triaging. However, for women with ASC-US, more than halve tested negative and could be released from further follow-up. Figure 1 reproduces the meta analysis including 32 studies providing data of HPV infection in case of equivocal cervical cytology (ASC-US). The pooled prevalence of HPV infection, assessed with the Hybrid Capture 2 assay was 43% (95% CI: 39%-46%) (see Figure 1 and Table 2).Figure 1

Meta-analysis of the proportion of women with ASCUS or a borderline Pap smear that have a positive Hybrid Capture II test. Output generated by the Stata procedure metaprop.

The dataset contains author and year which identify each study, where tgroup corresponds with the triage group(ASCUS, LSIL, borderline dyskaryosis). num and denom indicates the number of women with a positive HPV test (HC2 assay) and total number of tested women such that $\mathit{\text{frac}}\left(\frac{\mathit{\text{num}}}{\mathit{\text{denom}}}\right)$ is the proportion with a positive HC2 test. se indicates the standard error computed as $\sqrt{\frac{\mathit{\text{frac}}(1-\mathit{\text{frac}})}{\mathit{\text{denom}}}}$ . lo and up are the lower and upper confidence intervals computed using the ‘exact’ method.