A Systematic Review of Tests for Postcolposcopy and Posttreatment Surveillance

Megan A. Clarke, Elizabeth R. Unger, Rosemary Zuna, Erin Nelson, Teresa M. Darragh, Miriam Cremer, Colleen K. Stockdale, Mark H. Einstein, Nicolas Wentzensen

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)148-156
Number of pages9
JournalJournal of lower genital tract disease
Volume24
Issue number2
DOIs
StatePublished - Apr 1 2020

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Keywords

  • HPV
  • cervical screening
  • colposcopy
  • management
  • systematic review
  • treatment

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