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HPV testing via self-collected samples showed usefulness
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HPV testing using samples collected by patients themselves is less sensitive than samples taken by clinicians, but self-collected samples may represent a useful additional screening tool for women reluctant to undergo gynecological examinations, recent study data suggest.
The meta-analysis evaluated the sensitivity and specificity of HPV testing on self-collected samples in the detection of underlying cervical intraepithelial neoplasia (CIN) or cancer. The accuracy of HPV testing on self-collected samples also was compared with the testing and processing of samples collected by clinicians.
The researchers conducted a search of the literature using PubMed, Embase and CENTRAL, focusing on papers published between 1990 and June 3, 2013. Eligible studies met the following criteria: a vaginal sample collected by the patient, followed by a clinician-collected sample; the self-sample was screened with a high-risk HPV test and the clinician sample underwent cytological analysis or HPV testing; all enrolled women (or all women with one or more positive tests) were tested to confirm the presence or absence of CIN grade 2 (CIN2) or worse. Bivariate normal- and random-effect models were used to pool the absolute accuracy and relative accuracy for detecting CIN2 or worse or CIN3 or worse in both tests. The researchers identified 36 studies for analysis, evaluating 154,556 women.
The researchers found that HPV testing on self-collected samples, on average, detected 76% of CIN2 or worse, and 84% of CIN3 or worse. In terms of excluding CIN2 or worse, the pooled absolute specificity of self-samples was 86% and the pooled specificity for excluding CIN3 or worse was 87%. There was low variation in the relative accuracy of HPV testing on self-samples vs. testing of clinician-taken samples across clinical settings, which allowed pooling of the relative accuracy across all studies.
HPV testing of self-samples had a lower pooled sensitivity than HPV testing on a clinician-taken sample for CIN2 or worse (ratio=0.88; 95% CI, 0.85-0.91) and for CIN3 or worse (ratio=0.89; 95% CI, 0.83-0.96). Specificity also was found to be lower in self-samples vs. clinician-collected samples for CIN2 or worse (ratio=0.96; 95% CI, 0.95-0.97) and for CIN3 or worse (ratio=0.96; 95% CI, 0.93-0.99). In HPV testing using signal-based assays, the self-samples showed less sensitivity and specificity than testing on clinician-taken samples. Conversely, some PCR-based HPV tests showed similar sensitivity in both self-collected samples and clinician samples.
“Particular attention should be given to the assessment of HPV testing on self-samples in low-income and middle-income countries that do not have the infrastructure for cytopathological assessment, and have a substantial burden of cervical cancer,” the researchers wrote. “In such countries, self-sampling could enable good screening coverage.”
Disclosure: Some of the researchers report various financial ties with Abbott, Gen-Probe, Hologic, Qiagen, Roche and Self-screen.
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