title: Diagnostic value of combination of HPV testing and cytology as compared to isolated cytology in screening cervical cancer: A meta-analysis.
abstract: OBJECTIVE
  The objective of this study was to assess the diagnostic value of combination of human papillomavirus (HPV) testing and cytology as compared to isolated cytology in screening cervical cancer.
  
  
  METHODS
  We searched public databases including PubMed and Embase before September 30, 2014. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) of the two methods from included studies were meta-analyzed. The summary receiver operating characteristic (SROC) curve was constructed, and the area under curve (AUC) and an index Q* were summarized. Besides, a two-sample Z-test was conducted to evaluate the differences of the two diagnostic modalities.
  
  
  RESULTS
  Totally eight studies were involved. The included studies showed significant heterogeneity in estimating sensitivity, specificity, positive LR, negative LR, and DOR in both methods. The results of the above indexes in combination method were 0.937 (95% confidence interval (CI): 0.925-0.948), 0.858 (95% CI: 0.855-0.860), 3.924 (95% CI: 2.037-7.559), 0.083 (95% CI: 0.033-0.210), and 51.563 (95% CI: 14.682-181.09), respectively. The AUC and Q* index were 0.8841 and 0.8763, respectively. The results for isolated method were 0.743 (95% CI: 0.716-0.768), 0.951 (95% CI: 0.949-0.953), 6.408 (95% CI: 2.322-17.683), 0.226 (95% CI: 0.112-0.460), and 30.897 (95% CI: 7.170-133.15), respectively. The AUC and Q* index were 0.8550 and 0.7859, respectively. Combination method was superior to isolated method (Z = 13.375, P < 0.01) in sensitivity, while was inferior to isolated method (Z = 56.935, P < 0.01) in specificity.
  
  
  CONCLUSIONS
  Combination of HPV testing and cytology may be appropriate for screening cervical cancer if conditions allow.
authors.affiliation: Department of Gynecology and Obstetrics, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Guo-Xian
authors.initials: GX
authors.lastname: Yang
authors.forename: Peng
authors.initials: P
authors.lastname: Shi
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Sun
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Li
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
mesh_terms: D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000472:pathogenicity; D011237:Predictive Value of Tests; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*