The Positive Predictive Value of High-Grade Squamous Intraepithelial Lesion on Cytology for the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 or Higher: A Systematic Review

Abstract

Cervical cancer is a major worldwide health problem. Therefore, regular cervical screening in order to make an early diagnosis can help to prevent cervical cancer, through identifying and treating preinvasive cervical lesions. The aim of this review is to evaluate the correlation between the cytological screening result and the final gold standard histological outcome in the diagnosis of cervical lesions. More specifically, the correlation between high-grade intraepithelial lesion (HSIL) on cytology and histological cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was intended, by calculating the positive predictive value (PPV). PPV is an important value from a clinical point of view. An electronic search was carried out in the electronic databases MEDLINE (through PubMed) and the Cochrane Library (last searched beginning of December 2017), supplemented with the related article feature in PubMed and snowballing. Article selection (predefined inclusion and exclusion criteria) and data extraction were evaluated by two independent reviewers (N.K. and A.V.L.). After identifying 1,146 articles, 27 articles were finally included in this systematic review, representing 28,783 cytological HSIL diagnoses in total. The PPV of HSIL was 77.5% (range: 45.4–95.2%) for the histological diagnosis of CIN2+ and 55.4% (range: 36.4–67.6%) for the diagnosis of CIN3+. In this systematic review, 77.5% of the HSIL-positive women eventually had a CIN2+ diagnosis. The diagnostic value of a cytological HSIL result (conventional or liquid-based cytology) in the diagnosis of CIN2+ lesions is good, but a combination of tests could raise this value.

Diagnostic accuracy of cytology for the detection of endometrial cancer in urine and vaginal samples

“…Cytology is an established technology for the detection of cancers and their precursors, for example of the bladder 31 , lung 32 and cervix 33 . Recent years have witnessed innovative solutions to the detection of Barrett's oesophagus 34 and oral cancer 35 using cytology, offering hope for early detection strategies 36 .…”

A retrospective study comparing the efficiency of recurrent LSIL cytology to high-grade cytology as predictors of high-grade cervical intraepithelial neoplasia or worse (CIN2+)

“…Cervical cytology is the main screening test in the South African public healthcare sector. This retrospective study of 344 women 19,20 Further studies have shown histologically confirmed CIN2+ ranging between 50% and 77%. [21][22][23] Additionally, a few studies have shown a decrease in PPV of HSIL cytology to detect CIN2+ after receiving the HPV vaccine.…”

Use of peripheral blood transcriptomic biomarkers to distinguish high‑grade cervical squamous intraepithelial lesions from low‑grade lesions

“…In current clinical practice, the tools used for cervical cancer screening and diagnosis include HPV testing, cytology testing, colposcopy and cervical biopsy. Although combinations of different techniques have improved the screening and diagnosis of cervical cancer, the sensitivity, specificity, reliability and repeatability are still unsatisfactory due to sampling errors and/or screening errors, and the final diagnosis is still dependent on cervical biopsy (36). Thus, the development of a sensitive, non-invasive approach for the screening and diagnosis of HSILs and LSILs is essential to complement existing techniques.…”