title: Is HPV DNA testing specificity comparable to that of cytological testing in primary cervical cancer screening? Results of a meta-analysis of randomized controlled trials.
abstract: Human-papillomavirus (HPV) DNA testing has been proposed as an alternative to primary cervical cancer screening using cytological testing. Review of the evidence shows that available data are conflicting for some aspects. The overall goal of the study is to update the performance of HPV DNA as stand-alone testing in primary cervical cancer screening, focusing particularly on the aspects related to the specificity profile of the HPV DNA testing in respect to cytology. We performed a meta-analysis of randomized controlled clinical trials. Eight articles were included in the meta-analysis. Three outcomes have been investigated: relative detection, relative specificity, and relative positive predictive value (PPV) of HPV DNA testing versus cytology. Overall evaluation of relative detection showed a significantly higher detection of CIN2+ and CIN3+ for HPV DNA testing versus cytology. Meta-analyses that considered all age groups showed a relative specificity that favored the cytology in detecting both CIN2+ and CIN3+ lesions whereas, in the ≥30 years' group, specificity of HPV DNA and cytology tests was similar in detecting both CIN2+ and CIN3+ lesions. Results of the pooled analysis on relative PPV showed a not significantly lower PPV of HPV DNA test over cytology. A main key finding of the study is that in women aged ≥30, has been found an almost overlapping specificity between the two screening tests in detecting CIN2 and above-grade lesions. Therefore, primary screening of cervical cancer by HPV DNA testing appears to offer the right balance between maximum detection of CIN2+ and adequate specificity, if performed in the age group ≥30 years.
authors.affiliation: Department of Health Sciences, Chair of Hygiene, Medical School, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pileggi
authors.forename: Domenico
authors.initials: D
authors.lastname: Flotta
authors.forename: Aida
authors.initials: A
authors.lastname: Bianco
authors.forename: Carmelo G A
authors.initials: CG
authors.lastname: Nobile
authors.forename: Maria
authors.initials: M
authors.lastname: Pavia
mesh_terms: D000328:Adult; D003581:Cytodiagnosis; D004279:DNA, Viral / Q000302:isolation & purification; D055088:Early Detection of Cancer; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology
chemical_list: D004279:DNA, Viral
keywords: HPV DNA test; cervical cancer screening; conventional cytology; specificity