title: Detection of human papillomavirus in sinonasal papillomas: systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and formal meta-analysis of the literature reporting on HPV detection in sinonasal papillomas. Since first reported in 1983, the etiological role for human papillomavirus (HPV) in sinonasal papillomas has been subject to increasing interest.
  
  
  METHODS
  A systematic review, with meta-analysis and formal meta-regression.
  
  
  METHODS
  Literature was searched through April 2012. The effect size was calculated as event rates (95% confidence interval [CI]), with homogeneity testing using Cochran's Q and I(2) statistics. Meta-regression was used to test the impact of study-level covariates (HPV detection method, geographic origin, papilloma type) on effect size, and potential publication bias was estimated using funnel plot symmetry.
  
  
  RESULTS
  Seventy-six studies were eligible covering 1,956 sinonasal papillomas from different geographic regions. Altogether, 760 (38.8%) cases tested HPV-positive; effect size 0.421 (95% CI 0.359-0.485, random effects model). The summary HPV prevalence was highest (65.3%) in exophytic papillomas (EP), followed by inverted papillomas (37.8%) and cylindrical cell papillomas (22.5%). In meta-analysis stratified by 1) HPV detection technique, 2) geographic study origin, and 3) papilloma type, the between-study heterogeneity was significant only for the papilloma types (P = .001). In meta-regression, HPV detection method (P = .102), geographic origin (P = .149), or histological type (P = .240) were not significant study-level covariates. Some evidence for publication bias was found only for studies on EP. In sensitivity analysis, all meta-analytic results were robust to all one-by-one study removals.
  
  
  CONCLUSIONS
  Variability in HPV detection rates in sinonasal papillomas is explained by their histological types (not by HPV detection method or geographic origin of study), but none of the three were significant study-level covariates in formal meta-regression.
authors.affiliation: Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland. kari.syrjanen@tyks.fi
authors.forename: Kari
authors.initials: K
authors.lastname: Syrjänen
authors.forename: Stina
authors.initials: S
authors.lastname: Syrjänen
mesh_terms: D006801:Humans; D009669:Nose Neoplasms / Q000473:pathology / Q000821:virology*; D010212:Papilloma / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D010255:Paranasal Sinus Neoplasms / Q000473:pathology / Q000821:virology*