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Study Urges More Clinical Research on Gynecologic Testing

Follow-up testing after cervical cancer treatment lacks an evidence-based strategy, researchers say

TUESDAY, March 31 (HealthDay News) -- While professional guidelines call for human papillomavirus (HPV) testing in the follow-up of treatment for cervical intraepithelial neoplasia (CIN), there is insufficient clinical research to guide the clinician in the selection of the test to use, according to a report in the April issue of the American Journal of Obstetrics & Gynecology.

In an effort to pool data for analysis, Benjamin K.S. Chan, of the Oregon Evidence-based Practice Center at the Oregon Health and Science University in Portland, and colleagues conducted a literature review for studies between 1992 and 2007 on testing strategies for HPV in follow-up for CIN. The researchers located and screened 1,107 articles on either polymerase chain reaction testing or hybrid capture testing (HC1 and HC2). Only 20 of the studies met the inclusion criteria for pooling and analysis.

The investigators found that studies on polymerase chain reaction testing were not suitable for combined analysis, but did pool data from five studies of HC2 testing and colposcopy. HC2 pooled sensitivity was calculated to be 90.7 percent, while pooled specificity was 74.6 percent. Pooled sensitivity for cervical cytologic testing was 76.6 percent, and pooled specificity was 89.7 percent. Ultimately, a long-term clinical trial of alternative testing strategies is needed to settle the issue, the researchers note.

"Limits on current knowledge are highlighted by our findings and include the lack of randomized controlled trials that compare follow-up strategies and the limited number of studies that applied a reference standard test (colposcopy) for all patients," the authors write.

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