@article{c6a2bdd78c8c458d85a2a2d73b57fde2,
title = "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% (τ2 = 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. ",
keywords = "HPV, cervical screening, colposcopy, management, systematic review, treatment",
author = "Clarke, {Megan A.} and Unger, {Elizabeth R.} and Rosemary Zuna and Erin Nelson and Darragh, {Teresa M.} and Miriam Cremer and Stockdale, {Colleen K.} and Einstein, {Mark H.} and Nicolas Wentzensen",
note = "Funding Information: 1Division of Cancer Epidemiology & Genetics, National Cancer Institute/NIH, Bethesda, MD; 2Centers for Disease Control, Atlanta, GA; 3Department of Pathology, College of Medicine, University of Oklahoma, Oklahoma City, OK; 4Department of Obstetrics and Gynecology, University of Texas San Antonio, San Antonio, TX; 5Department of Pathology, University of California San Francisco, San Francisco, CA; 6Women's Health, Cleveland Clinic, Cleveland, OH; 7Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA; and 8Department of Obstetrics, Gynecology & Women's Health, Rutgers New Jersey Medical School, Newark, NJ Reprint requests to: Megan Clarke, PhD, MHS, Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, 9609 Medical Center Dr, Rm 6E552, Rockville, MD 20892. E-mail: megan.clarke@nih.gov This study was supported by the Intramural Research Program of the National Cancer Institute (Z01CP010124-21) and the ASCCP. The conclusions, findings, and opinions expressed by authors do not necessarily reflect the official position of the US Department of Health and Human Services, National Institutes of Health, or the Centers for Disease Control and Prevention. IRB Status: Exempt. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s Web site (www.jlgtd.com). Copyright {\textcopyright} 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. DOI: 10.1097/LGT.0000000000000526 Funding Information: The guidelines effort received support from the National Cancer Institute and ASCCP. Participating organizations supported travel for their participating representatives. All participating consensus organizations, including the primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, writing of manuscript, and decision to submit for publication. No industry funds were used in the development of these guidelines. The corresponding authors had final responsibility for the submission decision.",
year = "2020",
month = apr,
day = "1",
doi = "10.1097/LGT.0000000000000526",
language = "English (US)",
volume = "24",
pages = "148--156",
journal = "Journal of Lower Genital Tract Disease",
issn = "1089-2591",
publisher = "Lippincott Williams and Wilkins",
number = "2",
}