Detection of human papillomavirus in sinonasal papillomas: Systematic review and meta-analysis

Objectives/Hypothesis: To perform a systematic review and formal meta‐analysis of the literature reporting on HPV detection in sinonasal papillomas. Since first reported in 1983, the etiological role for human papillomavirus (HPV) in sinonasal papillomas has been subject to increasing interest. Stud...

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Bibliographic Details
Published in:The Laryngoscope 2013-01, Vol.123 (1), p.181-192
Main Authors: Syrjanen, Kari, Syrjanen, Stina
Format: Article
Language:English
Subjects:
Confidence intervals
cylindrical cell
detection method
exophytic
geographic region
Human papillomavirus
Humans
inverted
Meta-analysis
meta-regression
Nose Neoplasms - pathology
Nose Neoplasms - virology
papilloma
Papilloma - epidemiology
Papilloma - pathology
Papilloma - virology
Papillomaviridae - isolation & purification
Papillomaviridae - pathogenicity
Papillomavirus Infections - diagnosis
Papillomavirus Infections - epidemiology
Papillomavirus Infections - pathology
Paranasal Sinus Neoplasms - pathology
Paranasal Sinus Neoplasms - virology
publication bias
Sinonasal (Schneiderian)
study heterogeneity
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Summary:Objectives/Hypothesis: To perform a systematic review and formal meta‐analysis of the literature reporting on HPV detection in sinonasal papillomas. Since first reported in 1983, the etiological role for human papillomavirus (HPV) in sinonasal papillomas has been subject to increasing interest. Study Design: A systematic review, with meta‐analysis and formal meta‐regression. Methods: Literature was searched through April 2012. The effect size was calculated as event rates (95% confidence interval [CI]), with homogeneity testing using Cochran's Q and I2 statistics. Meta‐regression was used to test the impact of study‐level covariates (HPV detection method, geographic origin, papilloma type) on effect size, and potential publication bias was estimated using funnel plot symmetry. Results: Seventy‐six studies were eligible covering 1,956 sinonasal papillomas from different geographic regions. Altogether, 760 (38.8%) cases tested HPV‐positive; effect size 0.421 (95% CI 0.359‐0.485, random effects model). The summary HPV prevalence was highest (65.3%) in exophytic papillomas (EP), followed by inverted papillomas (37.8%) and cylindrical cell papillomas (22.5%). In meta‐analysis stratified by 1) HPV detection technique, 2) geographic study origin, and 3) papilloma type, the between‐study heterogeneity was significant only for the papilloma types (P = .001). In meta‐regression, HPV detection method (P = .102), geographic origin (P = .149), or histological type (P = .240) were not significant study‐level covariates. Some evidence for publication bias was found only for studies on EP. In sensitivity analysis, all meta‐analytic results were robust to all one‐by‐one study removals. Conclusions: Variability in HPV detection rates in sinonasal papillomas is explained by their histological types (not by HPV detection method or geographic origin of study), but none of the three were significant study‐level covariates in formal meta‐regression. Laryngoscope, 2013
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.23688