p16INK4a immunocytochemistry versus human papillomavirus testing for triage of women with minor cytologic abnormalities: a systematic review and meta-analysis - PubMed (original) (raw)

Review

. 2012 Oct 25;120(5):294-307.

doi: 10.1002/cncy.21205. Epub 2012 Jun 14.

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Review

p16INK4a immunocytochemistry versus human papillomavirus testing for triage of women with minor cytologic abnormalities: a systematic review and meta-analysis

Jolien Roelens et al. Cancer Cytopathol. 2012.

Abstract

The best method for identifying women who have minor cervical lesions that require diagnostic workup remains unclear. The authors of this report performed a meta-analysis to assess the accuracy of cyclin-dependent kinase inhibitor 2A (p16(INK4a)) immunocytochemistry compared with high-risk human papillomavirus DNA testing with Hybrid Capture 2 (HC2) to detect grade 2 or greater cervical intraepithelial neoplasia (CIN2+) and CIN3+ among women who had cervical cytology indicating atypical squamous cells of undetermined significance (ASC-US) or low-grade cervical lesions (LSIL). A literature search was performed in 3 electronic databases to identify studies that were eligible for this meta-analysis. Seventeen studies were included in the meta-analysis. The pooled sensitivity of p16(INK4a) to detect CIN2+ was 83.2% (95% confidence interval [CI], 76.8%-88.2%) and 83.8% (95% CI, 73.5%-90.6%) in ASC-US and LSIL cervical cytology, respectively, and the pooled specificities were 71% (95% CI, 65%-76.4%) and 65.7% (95% CI, 54.2%-75.6%), respectively. Eight studies provided both HC2 and p16(INK4a) triage data. p16(INK4a) and HC2 had similar sensitivity, and p16(INK4a) has significantly higher specificity in the triage of women with ASC-US (relative sensitivity, 0.95 [95% CI, 0.89-1.01]; relative specificity, 1.82 [95% CI, 1.57-2.12]). In the triage of LSIL, p16(INK4a) had significantly lower sensitivity but higher specificity compared with HC2 (relative sensitivity, 0.87 [95% CI, 0.81-0.94]; relative specificity, 2.74 [95% CI, 1.99-3.76]). The published literature indicated the improved accuracy of p16(INK4a) compared with HC2 testing in the triage of women with ASC-US. In LSIL triage, p16(INK4a) was more specific but less sensitive.

Copyright © 2012 American Cancer Society.

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Figures

Figure 1

Figure 1

PRISMA-diagram: flowchart of study selection.

Figure 2

Figure 2

Meta-analysis of the sensitivity and specificity of p16INK4a immunostaining in the triage of women with ASC-US (left) or LSIL (right) to detect CIN2+ (top) and CIN3+ (bottom). Black square: summary point, small circles: individual studies; green line: SROC curve; interrupted brown line: 95% confidence ellipse.

Figure 3

Figure 3

HSROC plot of the relative sensitivity and specificity of p16INK4a immunostaining versus HC2 in the triage of women with ASC-US (top) or LSIL (bottom) to detect CIN2+ lesions.

Figure 4

Figure 4

Forest plot sensitivity (left) and specificity (right) ratios of p16INK4a triage versus HC2 in women with ASC-US (top) or LSIL (bottom) to detect CIN2+.

Comment in

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