Immediate referral to colposcopy vs. cytological surveillance for low-grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta-analysis of the literature

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Title: Immediate referral to colposcopy vs. cytological surveillance for low-grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta-analysis of the literature
Authors: Kyrgiou, M
Kalliala, I
Mitra, A
Ng, BKY
Raglan, O
Fotopoulou, C
Martin-Hirsch, P
Paraskevaidis, E
Arbyn, M
Item Type: Journal Article
Abstract: We performed a systematic review and meta-analysis to explore the optimum management strategy for women with atypical squamous cells of undetermined significance (ASCUS/borderline) or low-grade squamous intra-epithelial lesions (LSIL/mild dyskaryosis) cytological abnormalities at primary screening in the absence of HPV DNA test. We searched MEDLINE, EMBASE and CENTRAL and included randomised controlled trials comparing immediate colposcopy to cytological surveillance in women with ASCUS/LSIL. The outcomes of interest were occurrence of different histological grades of cervical intra-epithelial neoplasia (CIN) and default rates during follow-up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect model and with inverse variance weighting. Interstudy heterogeneity was assessed using I2 statistics. Six RCTs were included. Immediate colposcopy significantly increased detection of unimportant abnormalities as opposed to repeat cytology (koilocytosis:32% vs.21%, RR:1.49, 95%CI=1.17-1.90); CIN1:21% vs.8%, RR:2.58, 95%CI=1.69-3.94). Although immediate colposcopy detected CIN2, CIN2+ and CIN3+ earlier than cytology, the differences were no longer observed at 24 months (CIN3+:10.3 vs.11.9%, RR:1.02, 95%CI=0.53-1.97), with significant inters-study heterogeneity (p<0.001,I2=93%). Default risk was significantly higher for repeat cytology (6months: 6.3 vs.13.3%, RR:3.85, 95%CI=1.27-11.63; 12months: 6.3 vs.14.8%, RR:6.39, 95%CI=1.24-32.95; 24 months: 0.9 vs.16.1%, RR:19.1,95%CI=9.02-40.4). Detection of CIN2+ for cytological surveillance over two years is similar to that of immediate colposcopy, although patients may default. Colposcopy may be first choice when good compliance is not assured, but may increase detection of insignificant lesions. This emphasizes the need for a reflex triage test to distinguish women who need diagnostic work-up from those who can return to routine recall.
Issue Date: 12-Oct-2016
Date of Acceptance: 24-Aug-2016
URI: http://hdl.handle.net/10044/1/39553
DOI: https://dx.doi.org/10.1002/ijc.30419
ISSN: 1097-0215
Publisher: Wiley
Start Page: 216
End Page: 223
Journal / Book Title: International Journal of Cancer
Volume: 140
Issue: 1
Sponsor/Funder: British Society for Colposcopy and Cervical Pathology
Imperial College Healthcare Charity
Genesis Research Trust
Sigrid Juselius Foundation
Imperial College Healthcare Charity
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: N/A
7114/R17R
01020
N/A
ICiC funding 2015/16
Keywords: ASCUS
borderline
cervical intraepithelial neoplasia
cervix
colposcopy
cytology
low-grade squamous intraepithelial lesion
mild dyskaryosis
randomized controlled trials
smear
Oncology & Carcinogenesis
1112 Oncology And Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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