Colposcopic triage methods for detecting cervical intraepithelial neoplasia grade 3 after cytopathological diagnosis of low-grade squamous intraepithelial lesion: a systematic review on diagnostic tests

context and objective: the age-stratified performance of the oncogenic hpv-dna (human papillomavirus deoxyribonucleic acid) test for triage of low-grade squamous intraepithelial lesions (lsil) requires investigation. the objective of this study was to evaluate and compare the age-stratified performance (cutoff point: 35 years) of oncogenic hpv-dna testing and repeated cytological tests, for detecting cervical intraepithelial neoplasia grade 3 (cin3), in order to triage for lsil. design and setting: systematic review. studies were identified in nine electronic databases and in the reference lists of the articles retrieved. methods: the eligibility criteria consisted of initial cytological findings of lsil; subsequent oncogenic hpv-dna testing and repeated cytological tests; and cin3 detection. the quality assessment of diagnostic accuracy studies (quadas) guidelines were used for quality assessment. qualitative information synthesis was performed. results: out of 7,776 studies, 284 were identified as pertinent and three fulfilled the eligibility criteria. the cin3 prevalence ranged from 6% to 12%. the hpv-dna positivity rate ranged from 64% to 83%; sensitivity for cin3 detection ranged from 95.2% to 100%; and specificity was available in two studies (27% and 52%). the sensitivity of repeated cytological tests, in relation to the threshold for atypical squamous cells of undetermined significance (ascus), was available in two studies (33% and 90.8%); and specificity was available in one study (53%). conclusions: currently, there is no scientific evidence available that would prove that colposcopic triage using oncogenic hpv-dna testing to detect cin3 performs better than repeated cytological tests, among women with lsil aged 35 years and over.