Diagnostic accuracy of conventional Pap test, liquid-based cytology and human papillomavirus DNA testing in cervical cancer screening in Korea: a meta-analysis.

Oh, Jin Kyoung; Shin, Hai Rim; Gong, Gyungyub; Sohn, Jin Hee; Khang, Shin Kwang

doi:2008.30.2.178

Epidemiol Health > Volume 30(2); 2008 > Article

Original Article

Epidemiology and Health 2008;30(2): 178-187.
DOI: https://doi.org/10.4178/kje.2008.30.2.178 Published online Dec 31, 2008.

Diagnostic accuracy of conventional Pap test, liquid-based cytology and human papillomavirus DNA testing in cervical cancer screening in Korea: a meta-analysis.

Jin Kyoung Oh, Hai Rim Shin, Gyungyub Gong, Jin Hee Sohn, Shin Kwang Khang

¹National Cancer Control Research Institute, National CancerCenter, Goyang, Korea. hrshin@ncc.re.kr
²International Agency for Research on Cancer, Lyon, France.
³Department of Pathology, Asan Medical Center, University ofUlsan College of Medicine, Seoul, Korea.
⁴Department of Pathology, Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine, Seoul, Korea.

Received: Oct 2, 2008 Accepted after revision: Dec 15, 2008

Abstract

Objective: The aim of this study was to compare the diagnostic accuracy of the Pap test, liquid-based cytology (LBC), and human papillomavirus (HPV) testing used as screening methods for the early detection of cervical cancer in Korea. Materials and
Method:
Articles reporting the sensitivity and specificity of each screening method that were published between 1995 and March 2008 were retrieved from MEDLINE and KoreaMed. A meta-analysis was conducted to calculate pooled estimates for the sensitivity and specificity of each method. Only cases with histological confirmation were included, and cervical cancer was defined as samples exhibiting cervical intraepithelial neoplasia 2 or worse. In cytological tests, findings of atypical squamous cells of undetermined significance or worse were considered positive.
Results:
Of the 24 studies, 15 studies of the Pap test, 3 studies of LBC, and 4 studies of HPV met the inclusion criteria and were included in the meta-analysis. The meta-analysis showed that the sensitivity was highest for LBC (92%), followed by HPV testing (83%) and the Pap test (76%), and the specificity of LBC was the highest (79%), followed by the Pap test (76%) and HPV testing (59%). However, except for the sensitivity of LBC (heterogeneity p-value = 0.682), significant heterogeneity was found among the results of the studies (heterogeneity p-value < 0.0001). Discussion: Due to the significant heterogeneity among the studies, the results of this meta-analysis are limited in representing the accuracy of each test method. The accuracy and cost-effectiveness of cervical cancer screening methods should be further evaluated.

Keywords: sensitivity; specificity; Pap; liquid-based cytology; human papillomavirus; meta-analysis