A Systematic Review of Tests for Postcolposcopy and Posttreatment Surveillance

Abstract

Objective: For the 2019 ASCCP Risk-Based Management Consensus Guidelines, we conducted a systematic review of diagnostic assays for postcolposcopy and posttreatment management.

Materials and methods: A literature search was conducted to identify articles reporting on tests/assays for cervical cancer screening, triage, postcolposcopy surveillance, and posttreatment surveillance published between 2012 and 2019 in PubMed and Embase. Titles and abstracts were evaluated by co-authors for inclusion. Included articles underwent full-text review, data abstraction, and quality assessment. Pooled absolute pretest and posttest risk estimates were calculated for studies evaluating management of patients after treatment.

Results: A total of 2,862 articles were identified through the search. Of 50 articles on postcolposcopy, 5 were included for data abstraction. Of 66 articles on posttreatment, 23 were included for data abstraction and were summarized in the meta-analysis. The pooled posttreatment risk of cervical intraepithelial neoplasia (CIN) 2+ in all studies was 4.8% (95% CI = 3.4%-6.8%), ranging from 0.4%-19.5% (τ = 0.57) in individual studies. Among individuals testing negative for human papillomavirus (HPV) posttreatment, the risk of CIN 2+ was 0.69% (95% CI = 0.3%-1.5%); among individuals testing positive for HPV posttreatment, the risk of CIN 2+ was 18.3% (95% CI = 12.1%-26.6%) in all studies. All risk estimates were substantially higher for liquid-based cytology. The HPV-cytology co-testing provided slightly better reassurance compared with HPV alone at the cost of much higher positivity.

Conclusions: Despite a large number of published studies on postcolposcopy and posttreatment surveillance, only few met criteria for abstraction and were included in the meta-analysis. More high-quality studies are needed to evaluate assays and approaches that can improve management of patients with abnormal screening.

FIGURE 1

The PRISMA flow diagram illustrates the different phases of this systematic review. It includes the number of records identified and those that were included and excluded for postcolposcopy and posttreatment surveillance studies.

FIGURE 2

Posttest risks of CIN 2+ in postcolposcopy surveillance studies. The risks and 95% CIs of CIN 2+ for patients testing negative (A) and positive (B) are summarized on the forest plot according to which assay was used. ES indicates estimate.

FIGURE 3

Posttest risks of CIN 2+ in posttreatment surveillance studies evaluating HPV assays. The risks and 95% CIs of CIN 2+ for patients testing negative (A) and positive (B) are summarized on the forest plot. Results are stratified by studies that used HC2 and those that used other HPV assays. ES indicates estimate; FE, fixed effects; LR, likelihood ratio; RE, random effects.

FIGURE 4

Posttest risks of CIN 2+ in posttreatment surveillance studies evaluating cytology. The risks and 95% CIs of CIN 2+ for patients testing negative (A) and positive (B) are summarized on the forest plot. ES indicates estimate; FE, fixed effects; LR, likelihood ratio; RE, random effects.

FIGURE 5

Posttest risks of CIN 2+ in posttreatment surveillance studies evaluating HPV and cytology co-testing, HPV alone, and cytology. The risks and 95% CIs of CIN 2+ for patients testing negative (A) and positive (B) are summarized on the forest plot. ES indicates estimate; FE, fixed effects; LBC, liquid-based cytology; LR, likelihood ratio; RE, random effects.