title: Colposcopic triage methods for detecting cervical intraepithelial neoplasia grade 3 after cytopathological diagnosis of low-grade squamous intraepithelial lesion: a systematic review on diagnostic tests.
abstract: OBJECTIVE
  The age-stratified performance of the oncogenic HPV-DNA (human papillomavirus deoxyribonucleic acid) test for triage of low-grade squamous intraepithelial lesions (LSIL) requires investigation. The objective of this study was to evaluate and compare the age-stratified performance (cutoff point: 35 years) of oncogenic HPV-DNA testing and repeated cytological tests, for detecting cervical intraepithelial neoplasia grade 3 (CIN3), in order to triage for LSIL.
  
  
  METHODS
  Systematic review. Studies were identified in nine electronic databases and in the reference lists of the articles retrieved.
  
  
  METHODS
  The eligibility criteria consisted of initial cytological findings of LSIL; subsequent oncogenic HPV-DNA testing and repeated cytological tests; and CIN3 detection. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines were used for quality assessment. Qualitative information synthesis was performed.
  
  
  RESULTS
  Out of 7,776 studies, 284 were identified as pertinent and three fulfilled the eligibility criteria. The CIN3 prevalence ranged from 6% to 12%. The HPV-DNA positivity rate ranged from 64% to 83%; sensitivity for CIN3 detection ranged from 95.2% to 100%; and specificity was available in two studies (27% and 52%). The sensitivity of repeated cytological tests, in relation to the threshold for atypical squamous cells of undetermined significance (ASCUS), was available in two studies (33% and 90.8%); and specificity was available in one study (53%).
  
  
  CONCLUSIONS
  Currently, there is no scientific evidence available that would prove that colposcopic triage using oncogenic HPV-DNA testing to detect CIN3 performs better than repeated cytological tests, among women with LSIL aged 35 years and over.
authors.affiliation: Cancer Control Program, Divisão de Apoio à Rede de Atenção Oncológica (DARAO), Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil. fcorrea@inca.gov.br
authors.forename: Flávia de Miranda
authors.initials: Fde M
authors.lastname: Corrêa
authors.forename: Fábio Bastos
authors.initials: FB
authors.lastname: Russomano
authors.forename: Caroline Alves de
authors.initials: CA
authors.lastname: Oliveira
mesh_terms: D000328:Adult; D000367:Age Factors; D003127:Colposcopy; D015344:DNA Probes, HPV; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000473:pathology*; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*
chemical_list: D015344:DNA Probes, HPV