Co-testing for detection of high-grade cervical intraepithelial neoplasia and cancer compared with cytology alone: a meta-analysis of randomized controlled trials
Co-testing for detection of high-grade cervical intraepithelial neoplasia and cancer compared with cytology alone: a meta-analysis of randomized controlled trials
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DOI：
10.1093/pubmed/fdt057
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发表时间：
2014-03-01
影响因子：
4.4
通讯作者：
Gonzalez-Gonzalez, Luis Alonso
中科院分区：
文献类型：
--
作者：
Bouchard-Fortier, Genevieve;Hajifathalian, Kaveh;Gonzalez-Gonzalez, Luis Alonso
人类乳头瘤病毒(HPV)DNA检测结合细胞学已被推荐为宫颈癌的主要筛查策略。在PubMed/MEDLINE、Embase、Cochrane图书馆和NIH试验注册中心搜索随机对照试验，比较联合检测和细胞学单独检测高度级别CIN病变和癌症。在确定的1156篇文章中，有4篇符合纳入标准。在基线筛查、第二轮筛查和总体筛查中比较联合检测和细胞学检查的表现。经累积Meta分析、Begins检验、Eggers检验和敏感性分析，在基线时，联合检测与CIN2的检出率[风险比(RR)1.41，95可信区间(CI)：1.12，1.76]显著相关，与CIN 3的检出率(RR 1.15，95CI：0.99，1.33)无显著相关。在第二轮筛查中，联合检测CIN 2和CIN 3的检出率显著降低(RR0.77，95CI：0.63，0.93；RR068，95CI：0.55，0.85)。对于CIN2(RR：119，95 CI：0.99，1.46)或CIN3(RR：0.99，95 CI：0.87，1.14)，联合检测与细胞学检查的总体检测率没有差异。与单独细胞学检查相比，联合检测提高了基线时CIN2病变的检出率，显著降低了随后筛查时CIN2或CIN3病变的检出率。
Human papillomavirus (HPV) DNA testing combined with cytology has been recommended as a primary cervical cancer screening strategy.PubMed/MEDLINE, Embase, the Cochrane Library and the NIH trial registry were searched for randomized controlled trials comparing co-testing with cytology alone for the detection of high-grade CIN lesions and cancers. Of 1156 articles identified, four met inclusion criteria. The performance of co-testing and cytology alone was compared at baseline screening, second round screening and overall. Cumulative meta-analysis, Beggs test, Eggers test and sensitivity analysis were performed.At baseline, co-testing was associated with a significantly higher detection rate of CIN 2 [risk ratio (RR) 1.41, 95 confidence interval (CI): 1.12, 1.76] and a non-significantly higher CIN 3 detection rate (RR 1.15, 95 CI: 0.99, 1.33). At second round screening, co-testing was associated with significantly lower detection rates of both CIN 2 and CIN 3 (RR 0.77, 95 CI: 0.63, 0.93; RR 068, 95 CI: 0.55, 0.85). The overall detection rate did not differ between co-testing and cytology alone for CIN 2 (RR: 119, 95 CI: 0.99, 1.46) or CIN3 (RR: 0.99, 95 CI: 0.87, 1.14).Co-testing increases the detection of CIN2 lesions at baseline and significantly decreases the detection rates of CIN2 or CIN3 lesions at subsequent screening compared with cytology alone.