HPV prevalence and accuracy of HPV testing to detect high-grade cervical intraepithelial neoplasia
HPV prevalence and accuracy of HPV testing to detect high-grade cervical intraepithelial neoplasia
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DOI：
10.1002/ijc.26147
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发表时间：
2012-03-15
影响因子：
6.4
通讯作者：
Ronco, Guglielmo
中科院分区：
文献类型：
--
作者：
Giorgi-Rossi, Paolo;Franceschi, Silvia;Ronco, Guglielmo
在人乳头瘤病毒(HPV)高流行人群的宫颈癌筛查中使用高危(HR)人乳头瘤病毒(HPV)检测引起了关注。人类乳头状瘤病毒的流行对基于HPV检测的筛查效率的影响从未被直接评估过。HPV DNA检测对宫颈上皮内瘤变(CIN2+)2级或更严重(CIN2+)的特异性和阳性预测值(PPV)与HR HPV患病率之间的关系进行Meta回归分析。只包括使用杂交捕获2(HC2)的研究。国家收入(低、中、高)被用作先前筛查的指标。研究对象包括来自20个研究的26个人群。HR HPV患病率每增加10%，HC2特异性降低8.41%[95%可信区间：8.028.81]，PPV增加4.74%(95%可信区间：2.457.03)。HRHPV患病率解释了HC2特异性变异的98%和PPV变异的38%。国家收入不影响特异性，但低中等收入与较高的PPV(3.81%；95%CI：1.536.10)在调整HR HPV患病率后相关。当HR HPV流行率较高时，HPV检测CIN2+的特异性降低，但PPV不会降低，在筛查不充分的人群中其特异性很高。因此，每个发现的CIN2+病例中需要进一步评估或治疗的HPV阳性妇女人数将会减少，筛查效率将会提高。这是由HR HPV导致CIN2+的事实解释的：HR HPV患病率的增加不可避免地伴随着CIN2+的增加。
Concern was raised on using testing for high-risk (HR) human papillomavirus (HPV) in cervical cancer screening in populations where HPV prevalence is high. The impact of HR HPV prevalence on the efficiency of HPV test-based screening has never been directly evaluated. A meta-regression of the relationship between HR HPV prevalence and the specificity and positive predictive value (PPV) of HPV DNA testing for the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was performed. Only studies that used Hybrid Capture 2 (HC2) were included. Country income (lowmedium vs. high) was used as a proxy of previous screening. Twenty-six populations from 20 studies were included. For a 10% increase in HR HPV prevalence, HC2 specificity decreased by 8.41% [95% confidence interval (CI): 8.028.81], whereas PPV increased by 4.74% (95% CI: 2.457.03). HR HPV prevalence explained 98% of the variability in HC2 specificity and 38% of the variability in PPV. Country income did not affect specificity, but lowmedium income was associated with higher PPV (3.81%; 95% CI: 1.536.10) after adjustment for HR HPV prevalence. When HR HPV prevalence is high, the specificity of HPV testing for CIN2+ decreases, but PPV does not decrease and it is high in inadequately screened populations. The number of HPV-positive women needing further assessment or treatment per CIN2+ case detected will therefore decrease and screening efficiency will improve. This is explained by the fact that HR HPV causes CIN2+: an increase in HR HPV prevalence is inevitably accompanied by an increase in CIN2+.