Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among women living with HIV: A systematic review and meta-analysis.
Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among women living with HIV: A systematic review and meta-analysis.
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DOI：
10.1016/j.eclinm.2022.101645
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发表时间：
2022-11
影响因子：
15.1
通讯作者：
de Sanjose, Silvia
中科院分区：
文献类型：
--
作者：
Kelly, Helen;Jaafar, Iman;Chung, Michael;Michelow, Pamela;Greene, Sharon;Strickler, Howard;Xie, Xianhong;Schiffman, Mark;Broutet, Nathalie;Mayaud, Philippe;Dalal, Shona;Arbyn, Marc;de Sanjose, Silvia
我们系统地回顾了对感染艾滋病毒的女性（WLHIV）进行宫颈癌筛查和分流策略的诊断准确性。
我们检索了Cochrane图书馆、Embase、全球健康数据库和Medline，查找从数据库建立到2022年7月15日发表的随机对照试验、前瞻性或横断面研究，这些研究报告了在宫颈癌筛查以及对筛查阳性的WLHIV进行分流时检测的诊断准确性。如果研究报告了任何宫颈癌筛查或分流策略在WLHIV中检测经组织学确诊的高级别宫颈上皮内瘤变（CIN2 + /CIN3 +）的诊断准确性，则将其纳入。从已发表的报告中提取汇总数据。在适用的情况下，联系作者获取缺失数据。使用诊断准确性数据的荟萃分析模型对CIN2/3 +的敏感性和特异性估计值进行合并。使用QUADAS - 2工具对诊断准确性研究进行质量评估。PROSPERO注册号：CRD42020189031。
在涉及18737名WLHIV的38项研究中，大多数（n = 19）在撒哈拉以南非洲进行。CIN2 +的合并患病率为12.0%（95%置信区间：9.8 - 14.1），CIN3 +的合并患病率为6.7%（95%置信区间：5.0 - 8.4）。筛查阳性的比例范围为：使用醋酸目视检查（VIA）为3 - 31%；高级别鳞状上皮内病变及更严重情况（HSIL +）细胞学检查为2 - 46%；高危型（HR）-HPV DNA检测为20 - 64%。在14项研究中，VIA的敏感性和特异性存在差异，限制了合并估计值的可靠性。在5项大多数经组织学确诊为CIN2 +的研究中，CIN2 +的合并敏感性为56.0%（95%置信区间：45.4 - 66.1；I² = 65%），CIN3 +的合并敏感性为65.0%（95%置信区间：52.9 - 75.4；I² = 42%）；＜CIN2的特异性为73.8%（95%置信区间：59.8 - 84.2，I² = 94%）。细胞学检查同样存在差异（ASCUS +对CIN2 +的敏感性范围：58 - 100%；特异性：9 - 96%）。在28项研究中，针对14种高危型HPV类型的检测敏感性较高（CIN2 +为91.6%，95%置信区间：88.1 - 94.1；I² = 45%，CIN3 +为92.5%，95%置信区间：88.4 - 95.2；I² = 32%）；但＜CIN2的特异性较低（62.2%（95%置信区间：57.9 - 66.4；I² = 92%）。限制为8种高危型HPV可提高特异性（65.8%；相对特异性[RSpec]与14种高危型HPV相比 = 1.17；95%置信区间：1.10 - 1.24），敏感性无显著变化（CIN2 +：85.5%；相对敏感性[RSens] = 0.94，95%置信区间：0.89 - 1.00；CIN3 +：90%；RSens = 0.96，95%置信区间：0.89 - 1.03）。对14种高危型HPV阳性女性进行VIA分流，与单独进行HPV - DNA检测相比，CIN2 +的敏感性降低（64.4%对91.6%；RSens = 0.68，95%置信区间：0.62 - 0.75）。
与VIA或细胞学检查相比，基于HPV - DNA的方法对CIN2 + /CIN3 +始终显示出更高的敏感性。针对多达14种高危型HPV的基于HPV - DNA的方法特异性较低，通过限制为8种高危型HPV可显著提高特异性，且敏感性仅有轻微损失，从而减少了对分流的需求，而最佳分流方法尚不明确。
世界卫生组织；美国国家癌症研究所；欧盟的“地平线2020”计划和玛丽·居里行动计划。
We systematically reviewed the diagnostic accuracy of cervical cancer screening and triage strategies in women living with HIV (WLHIV). Cochrane Library, Embase, Global Health and Medline were searched for randomised controlled trials, prospective or cross-sectional studies published from database inception to 15 July 2022 reporting diagnostic accuracy of tests in cervical cancer screening and triage of screen-positive WLHIV. Studies were included if they reported the diagnostic accuracy of any cervical cancer screening or triage strategies for the detection of histologically-confirmed high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among WLHIV. Summary data were extracted from published reports. Authors were contacted for missing data where applicable. Sensitivity and specificity estimates for CIN2/3+ were pooled using models for meta-analysis of diagnostic accuracy data. Study quality was assessed using the QUADAS-2 tool for the quality assessment of diagnostic accuracy studies. PROSPERO registration:CRD42020189031. In 38 studies among 18,737 WLHIV, the majority (n=19) were conducted in sub-Saharan Africa. The pooled prevalence was 12.0% (95%CI:9.8-14.1) for CIN2+ and 6.7% (95%CI:5.0-8.4) for CIN3+. The proportion of screen-positive ranged from 3-31% (visual inspection using acetic acid[VIA]); 2-46% (high-grade squamous intraepithelial lesions, and greater [HSIL+] cytology); 20-64% (high-risk[HR]-HPV DNA). In 14 studies, sensitivity and specificity of VIA were variable limiting the reliability of pooled estimates. In 5 studies where majority had histology-confirmed CIN2+, pooled sensitivity was 56.0% (95%CI:45.4-66.1; I2=65%) for CIN2+ and 65.0% (95%CI:52.9-75.4; I2=42%) for CIN3+; specificity for <CIN2 was 73.8% (95%CI:59.8-84.2, I2=94%). Cytology was similarly variable (sensitivity of ASCUS+ for CIN2+ range: 58-100%; specificity: 9-96%). In 28 studies, sensitivity of tests targeting 14-HR-HPV types was high (91.6%, 95%CI:88.1-94.1; I2=45% for CIN2+ and 92.5%, 95%CI:88.4-95.2; I2=32%) for CIN3+); but specificity for <CIN2 was low (62.2% (95%CI:57.9-66.4;I2=92%). Restriction to 8-HR-HPV increased specificity (65.8%; Relative specificity[RSpec] vs. 14-HR-HPV=1.17; 95%CI:1.10-1.24) with no significant change in sensitivity (CIN2+:85.5%; Relative Sensitivity[RSens]=0.94, 95%CI: 0.89-1.00; CIN3+:90%; RSens=0.96, 95%CI:0.89-1.03). VIA triage of 14-HR-HPV positive women decreased sensitivity for CIN2+ compared to HPV-DNA test alone (64.4% vs. 91.6%; RSens=0.68, 95%CI:0.62-0.75). HPV-DNA based approaches consistently showed superior sensitivity for CIN2+/CIN3+ compared to VIA or cytology. The low specificity of HPV-DNA based methods targeting up to 14-HR-HPV could be improved significantly by restricting to 8-HR-HPV with only minor losses in sensitivity, limiting requirement for triage for which optimal approaches are less clear. World Health Organisation; National Cancer Institute; European Union's Horizon 2020 and Marie Skłodowska-Curie Actions programme.
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赞比亚卢萨卡的HIV感染妇女的宫颈癌筛查数字宫颈造影和细胞学的临床性能。
DOI：
10.1097/qai.0000000000000270
发表时间：
2014-10-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Bateman AC;Parham GP;Sahasrabuddhe VV;Mwanahamuntu MH;Kapambwe S;Katundu K;Nkole T;Mulundika J;Pfaendler KS;Hicks ML;Shibemba A;Vermund SH;Stringer JS;Chibwesha CJ
通讯作者：
Chibwesha CJ
影响因子：
28.2
作者：
Delory, Tristan;Ngo-Giang-Huong, Nicole;Le Coeur, Sophie
通讯作者：
Le Coeur, Sophie
影响因子：
34.3
作者：
Arbyn, Marc;Weiderpass, Elisabete;Bray, Freddie
通讯作者：
Bray, Freddie
影响因子：
1.3
作者：
Branca, M;Rossi, E;Syrjänen, K
通讯作者：
Syrjänen, K
影响因子：
6.4
作者：
Giorgi-Rossi, Paolo;Franceschi, Silvia;Ronco, Guglielmo
通讯作者：
Ronco, Guglielmo