title: The APTIMA HPV assay versus the Hybrid Capture 2 test in triage of women with ASC-US or LSIL cervical cytology: a meta-analysis of the diagnostic accuracy.
abstract: Testing for DNA of 13 high-risk HPV types with the Hybrid Capture 2 (HC2) test has consistently been shown to perform better in triage of women with cervical cytology results showing atypical squamous cells of undetermined significance (ASC-US) but often not in triage of low-grade squamous intraepithelial lesions (LSIL) detected in cervical cancer screening. In a meta-analysis, we compared the accuracy of the APTIMA HPV test, which identifies RNA of 14 high-risk HPV types, to HC2 for the triage of women with ASC-US or LSIL. Literature search-targeted studies where the accuracy of APTIMA HPV and HC2 for detection of underlying CIN2/3+ was assessed concomitantly including verification of all cases of ASC-US and LSIL. HSROC (Hierarchical Summary ROC) curve regression was used to compute the pooled absolute and relative sensitivity and specificity. Eight studies, comprising 1,839 ASC-US and 1,887 LSIL cases, were retrieved. The pooled sensitivity and specificity of APTIMA to triage ASC-US to detect underlying CIN3 or worse was 96.2% (95% CI = 91.7-98.3%) and 54.9% (95% CI = 43.5-65.9%), respectively. APTIMA and HC2 showed similar pooled sensitivity; however, the specificity of the former was significantly higher (ratio: 1.19; 95% CI = 1.08-1.31 for CIN2+). The pooled sensitivity and specificity of APTIMA to triage LSIL were 96.7% (95% CI = 91.4-98.9%) and 38.7% (95% CI = 30.5-47.6%) for CIN3+. APTIMA was as sensitive as HC2 but more specific (ratio: 1.35; 95% CI = 1.11-1.66). Results were similar for detection of CIN2 or worse. In both triage of ASC-US and LSIL, APTIMA is as sensitive but more specific than HC2 for detecting cervical precancer.
authors.affiliation: Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium. marc.arbyn@wiv-isp.be
authors.forename: Marc
authors.initials: M
authors.lastname: Arbyn
authors.forename: Jolien
authors.initials: J
authors.lastname: Roelens
authors.forename: Kate
authors.initials: K
authors.lastname: Cuschieri
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Ann
authors.initials: A
authors.lastname: Szarewski
authors.forename: Sam
authors.initials: S
authors.lastname: Ratnam
authors.forename: Miriam
authors.initials: M
authors.lastname: Reuschenbach
authors.forename: Suzanne
authors.initials: S
authors.lastname: Belinson
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Belinson
authors.forename: Joseph
authors.initials: J
authors.lastname: Monsonego
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000737:chemistry* / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D061809:Human Papillomavirus DNA Tests / Q000379:methods*; D006801:Humans; D027383:Papillomaviridae / Q000737:chemistry* / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000821:virology*
chemical_list: D004279:DNA, Viral