title: Human papillomavirus testing in primary cervical screening and the cut-off level for hybrid capture 2 tests: systematic review.
abstract: OBJECTIVE
  To determine the trade-off between the sensitivity and the specificity for high grade cervical intraepithelial neoplasia at hybrid capture 2 cut-off values above the standard ≥ 1 relative light units/cut-off level (rlu/co).
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  PubMed.
  
  
  METHODS
  Randomised controlled trials in primary cervical screening using hybrid capture 2 testing in the intervention arms. Articles published until August 2010 were included if the numbers of women with positive test results and with cervical intraepithelial neoplasia were stratified by hybrid capture 2 cut-off levels.
  
  
  METHODS
  Women in the baseline screening rounds of the trials.
  
  
  METHODS
  Hybrid capture 2 screening in the baseline round including the diagnostic follow-up as practised in the randomised controlled trials and as reported by hybrid capture 2 cut-off values.
  
  
  RESULTS
  Owing to heterogeneity in the trials, meta-analysis was not possible. Including cut-off values up to ≥ 10 rlu/co, 25 observation points were available for analysis. The relative sensitivity for cervical intraepithelial neoplasia grade III or higher at cut-off levels of ≥ 2, ≥ 4 or ≥ 5, and ≥ 10 rlu/co compared with a cut-off level of ≥ 1 rlu/co varied by trial, but at their lowest they were 0.97, 0.92, and 0.91, respectively. A similar pattern was observed for cervical intraepithelial neoplasia grade II or higher. The specificity would increase by at least 1%, 2%, and 3%, respectively, so that up to 24%, 39%, and 53%, of positive hybrid capture 2 test results not associated with high grade neoplasia could be avoided. Only two outliers existed to this general pattern.
  
  
  CONCLUSIONS
  Although the data were derived from the baseline screening rounds only, the decrease in the sensitivity for high grade cervical intraepithelial neoplasia using a hybrid capture 2 cut-off level between ≥ 2 rlu/co and ≥ 10 rlu/co seemed acceptable given the international recommendations for testing for human papillomavirus DNA in cervical screening, which require 90% or more sensitivity for cervical intraepithelial neoplasia grade II or higher compared with hybrid capture 2 at ≥ 1 rlu/co. The data suggest that the hybrid capture 2 cut-off level could be increased in primary screening; this seems reasonably safe and is significantly less burdensome for women.
authors: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 København K, Denmark. mare@sund.ku.dk
authors: Matejka
authors: M
authors: Rebolj
authors: Jesper
authors: J
authors: Bonde
authors: Sisse Helle
authors: SH
authors: Njor
authors: Elsebeth
authors: E
authors: Lynge
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