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Vaughan L, Gary D, Shah M, Lewellen L, Galbraith L, Parvu V. Variables that impact HPV test accuracy during vaginal self collection workflow for cervical cancer screening. Gynecol Oncol Rep 2024; 54:101421. [PMID: 38881560 PMCID: PMC11176621 DOI: 10.1016/j.gore.2024.101421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Vaginal self collection (SC) is safe and effective for human papillomavirus (HPV) testing and can increase cervical cancer screening coverage for underserved women. To better understand the impact of SC methodology on HPV test outcomes, empirical testing was conducted using different swab collection workflows. Deposition of the collection swab into resuspension buffer resulted in a 2.4-cycle reduction in threshold detection of human beta-hemoglobin during PCR when compared to "swirl-and-toss". In addition, reducing the swab resuspension volume from 10 mL to 3 mL resulted in a 2.6-cycle reduction in threshold detection of human beta-globin. A systematic literature search (01/01/2020 to 08/02/2023) of Ovid Medline and Embase, followed by data extraction and analysis, was conducted to further assess the impact of resuspension volume on performance following SC. HPV test performance for SC, relative to clinician collection (CC), was calculated for detection of cervical pre-cancer. Data were stratified by the resuspension volume ratio of SC to CC being either ≥ 1.0 or < 1.0. SC with a volume ratio of ≥ 1.0 and < 1.0 had a relative ≥ CIN2 sensitivity of 92.0 % (95 % CI: 88.0, 96.0) and 97.0 % (95 % CI: 94.0, 100), respectively. Taken together, these results suggest that SC conditions can be modified to optimize sample recovery and performance, as part of cervical cancer screening.
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Affiliation(s)
- Laurence Vaughan
- Scientific Affairs, Becton, Dickinson and Company, BD Life Sciences - Diagnostic Solutions, 7 Loveton Circle, Sparks, MD 21152, USA
| | - Devin Gary
- Scientific Affairs, Becton, Dickinson and Company, BD Life Sciences - Diagnostic Solutions, 7 Loveton Circle, Sparks, MD 21152, USA
| | - Millie Shah
- Research and Development, Becton, Dickinson and Company, BD Life Sciences - Diagnostic Solutions, 54 Loveton Circle, Sparks, MD 21152, USA
| | - Lyndsay Lewellen
- Research and Development, Becton, Dickinson and Company, BD Life Sciences - Diagnostic Solutions, 54 Loveton Circle, Sparks, MD 21152, USA
| | - Laura Galbraith
- Research and Development, Becton, Dickinson and Company, BD Life Sciences - Diagnostic Solutions, 54 Loveton Circle, Sparks, MD 21152, USA
| | - Valentin Parvu
- Scientific Affairs, Becton, Dickinson and Company, BD Life Sciences - Diagnostic Solutions, 7 Loveton Circle, Sparks, MD 21152, USA
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Pasquier C, Raymond S, Duchanois D, Sauné K, Oliveira-Mendes K, Vayssiere C, Izopet J. Human papillomavirus testing using HPV APTIMA® assay and an external cellularity control in self-collected samples. J Med Virol 2023; 95:e29283. [PMID: 38088528 DOI: 10.1002/jmv.29283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
In cervical cancer screening programs, the detection of high-risk human papillomavirus (HR-HPV) is now widely implemented on physician-collected samples and has expanded to include self-collected samples. The use of a cellularity control (CC) is needed to reduce false-negative HPV results. An external mRNA CC for the HPV APTIMA® assay was assessed for its analytical performance and the results were compared with both cervix cytobrush samples taken by physicians and self-collected vaginal samples from 148 women. The performance of the CC was adjusted to control for the presence of cellular mRNA in the ThinPrep® and Multitest® transport media. This CC is user-friendly but implies to perform two independent assays on PANTHER® automate. Self-collected vaginal sampling gives a lower median CC results (13.2 vs. 16.9 min) but a higher risk of negative CC results (3.3 vs. 0%). The usefulness of the CC for the HR-HPV assay may be optimized by the definition of a threshold for a minimum cell number to be tested to increase confidence in HPV-negative results. The systematic use of an RNA CC increases confidence for HPV RNA assays on self-collected vaginal samples.
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Affiliation(s)
| | - Stéphanie Raymond
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | - Delphine Duchanois
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Karine Sauné
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | | | - Christophe Vayssiere
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Jacques Izopet
- Department of Virology, Toulouse University Hospital, Toulouse, France
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Sechi I, Muresu N, Puci MV, Saderi L, Del Rio A, Cossu A, Muroni MR, Castriciano S, Martinelli M, Cocuzza CE, Sotgiu G, Piana A. Preliminary Results of Feasibility and Acceptability of Self-Collection for Cervical Screening in Italian Women. Pathogens 2023; 12:1169. [PMID: 37764977 PMCID: PMC10535381 DOI: 10.3390/pathogens12091169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Given the diagnostic accuracy of HPV-DNA tests in terms of self-collected samples, in order to implement self-sampling in cervical screening programs, the standardization of the pre-analytical phase, including decisions concerning the choice of medium, the volume of elution, and storage conditions, are necessary, in addition to understanding the potential factors involved in acceptability by women. On this basis, we carried out a cross-sectional study to assess (i) the stability of dry vaginal self-collected samples stored at room temperature for up to 4 weeks after elution in 2 mL of eNat® (Copan) medium, and (ii) the acceptability of self-collection in enrolled women. METHODS 185 women were enrolled in the LILT (Italian League Against Tumors) regional project. A self-sampling kit, including a dry FLOQSwab® (Copan), instructions for use, and a satisfaction questionnaire, were supplied for each woman and sent by mail to the laboratory. The HPV-DNA test was carried out using the Anyplex™ II HPV HR (Seegene) kit. To evaluate the specimen's stability, 185 dry vaginal swabs were eluted in eNat®, a lyses-based molecular medium and tested for HPV detection at two different time points (<6 days and 1 month after elution). The Cohen's Kappa coefficients and McNemar test were used to assess the agreement of HPV-DNA at different times. RESULTS We found high agreement in terms of HPV-DNA results among the samples tested at two different time points (Cohen K = 0.98; p < 0.0001). Moreover, most of the women found it easy to use self-collection devices and the pictorial instructions clear to understand. Approximately half of the enrolled women declared preferring self-sampling to clinician-collected methods. CONCLUSION Our results display the high reliability and accuracy of HPV-DNA tests using dry vaginal self-collection FLOQSwabs® devices eluted in 2 mL of molecular medium. The analysis of the questionnaire showed a high acceptability of self-collection among women, although a high percentage preferred standard collection devices. Overall, our preliminary results support the adoption of self-collection in screening programs, even though further analyses should be performed to optimize and standardize protocols for HPV tests on self-samples, and educational campaigns are needed to adequately inform and increase responsiveness in a target population.
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Affiliation(s)
- Illari Sechi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
| | - Narcisa Muresu
- Department of Humanities and Social Sciences, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari-Padre Manzella 4 Street, 07100 Sassari, Italy; (M.V.P.); (L.S.); (G.S.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari-Padre Manzella 4 Street, 07100 Sassari, Italy; (M.V.P.); (L.S.); (G.S.)
| | - Arcadia Del Rio
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy;
| | - Andrea Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
| | - Maria R. Muroni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
| | | | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore 48 street, 20900 Monza, Italy; (M.M.); (C.E.C.)
| | - Clementina E. Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore 48 street, 20900 Monza, Italy; (M.M.); (C.E.C.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari-Padre Manzella 4 Street, 07100 Sassari, Italy; (M.V.P.); (L.S.); (G.S.)
| | - Andrea Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
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Shih YH, Sun L, Hsu ST, Chen MJ, Lu CH. Can HPV Test on Random Urine Replace Self-HPV Test on Vaginal Self-Samples or Clinician-Collected Cervical Samples? Int J Womens Health 2023; 15:1421-1429. [PMID: 37719784 PMCID: PMC10504088 DOI: 10.2147/ijwh.s416520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Abstract
Objective This study investigated whether random urine (RU) samples can be used to accurately identify human papillomavirus (HPV) and whether these samples can replace self-collected vaginal samples in HPV tests. Methods A total of 167 patients with abnormal Pap smears were recruited. The patients provided self-collected vaginal and RU samples for HPV testing. Clinicians obtained cervical samples from the patients. Colposcopy examination and cervical biopsy were performed. Hybrid Capture II (HC II) and Cervista tests were used to detect HPV in the RU samples. Results The results of tests on clinician-collected cervical samples were used as the benchmark. The sensitivities of the Cervista tests on vaginal samples and the HC II and Cervista tests on RU samples were 75.00%, 49.07%, and 44.44%, respectively. After we adjusted the HPV detection cutoff value for urine samples based on values in the receiver operating characteristic curve, the sensitivities of the HC II and Cervista tests increased to 63.89% and 58.33%, respectively. In 167 patients, 59 had cervix biopsies showing CIN2 or worse (CIN2+). For CIN2+, the sensitivity was 47.5% and 50.8% in the HC II and Cervista tests on RU samples, respectively. Conclusion HPV tests on RU samples had approximately 60% sensitivity to HPV tests on clinician-collected cervical samples after the cutoff values were adjusted. For CIN2+, the sensitivity was only approximately 50%. Further studies and improvements in urine-based HPV testing are needed to establish it as a more convenient and accessible method for detecting HPV and cervical dysplasia in patients.
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Affiliation(s)
- Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lou Sun
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Jer Chen
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
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Martinelli M, Giubbi C, Sechi I, Bottari F, Iacobone AD, Musumeci R, Perdoni F, Muresu N, Piana A, Fruscio R, Landoni F, Cocuzza CE. Evaluation of BD Onclarity™ HPV Assay on Self-Collected Vaginal and First-Void Urine Samples as Compared to Clinician-Collected Cervical Samples: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12123075. [PMID: 36553082 PMCID: PMC9776973 DOI: 10.3390/diagnostics12123075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
The accuracy of available HPV molecular assays on self-samples needs to be evaluated as compared to clinician-collected samples. This pilot study aimed to investigate the BD Onclarity™ HPV assay on vaginal and first-void urine samples. Sixty-four women referred to colposcopy for cervical dysplasia performed a vaginal self-collection and provided a first-void urine sample, after informed consent. A cervical specimen was collected during the clinician examination. All samples were tested using BD Onclarity™ HPV assay on the BD Viper™ LT System. Overall positive agreement (OPA) between cervical and self-sample results was evaluated using Cohen's kappa value (κ). Using a clinical cut-off of 38.3 Ct for HPV 16 and 34.2 Ct for other HR genotypes, compared to cervical sample, the self-collected vaginal sample OPA was 85.9%, and κ = 0.699. Without a clinical cut-off, the OPA was 95.3%, and the κ = 0.890. Data obtained comparing cervical and urine samples showed an OPA of 87.5% with a κ = 0.79 using a clinical cut-off, and an OPA of 90.6% with a κ = 0.776 without a clinical cut-off. Data showed a substantial agreement between both self-collected and clinician-collected samples. A specific clinical cut-off analysis should be considered based on type of sample analysed.
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Affiliation(s)
- Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Giubbi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Illari Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Anna Daniela Iacobone
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Rosario Musumeci
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Perdoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Narcisa Muresu
- Department of Humanities and Social Sciences, University of Sassari, 07100 Sassari, Italy
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca, 20900 Monza, Italy
| | - Fabio Landoni
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca, 20900 Monza, Italy
| | - Clementina Elvezia Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-02-64488358
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Lamsisi M, Li G, Chauleur C, Ennaji MM, Bourlet T. The potential of urine for human papillomavirus-related cervical cancer prevention. Future Virol 2022. [DOI: 10.2217/fvl-2021-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cervical cancer is one of the most preventable cancers. The introduction of human papillomavirus (HPV) vaccines and the adaptation of regular screening programs are key actions that need to be generalized globally to achieve the goal of cervical cancer elimination. However, it is still challenging to achieve satisfactory coverage rate, and many women are reluctant to participate in gynecologic examination. In this article, we review the research on the application of HPV detection in urine samples for cervical cancer screening and vaccine monitoring, as well as discuss the technical challenges and new technological advancements in urine-based tests. HPV detection in urine is an excellent noninvasive alternative that is widely accepted by women, relatively affordable, and provides the potential to reach women without the necessity for clinical visits. Thus, it is an attractive tool for both cervical cancer screening and vaccine monitoring.
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Affiliation(s)
- Maryame Lamsisi
- Team of Virology, Oncology & Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, & Biotechnologies/ETB, Faculty of Science & Techniques Mohammedia, Hassan II University of Casablanca, 20650, Mohammedia, Morocco
| | - Guorong Li
- Department of Urology/Biology Pathology Lab, North Hospital, CHU Saint-Etienne, 42000, Saint Etienne, France
| | - Celine Chauleur
- Deparment of Gynecology & Obstetrics, North Hospital, CHU Saint-Etienne, 42000, Saint Etienne, France
| | - Moulay Mustapha Ennaji
- Team of Virology, Oncology & Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, & Biotechnologies/ETB, Faculty of Science & Techniques Mohammedia, Hassan II University of Casablanca, 20650, Mohammedia, Morocco
| | - Thomas Bourlet
- Department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42000, Saint Etienne, France
- Centre International de Recherche en Infectiologie, GIMAP Team 15, Inserm, U1111, CNRS, UMR5308, University of Saint-Etienne, University of Lyon, 42000, Saint Etienne, France
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Sechi I, Elvezia CC, Martinelli M, Muresu N, Castriciano S, Sotgiu G, Piana A. Comparison of Different Self-Sampling Devices for Molecular Detection of Human Papillomavirus (HPV) and Other Sexually Transmitted Infections (STIs): A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10030459. [PMID: 35326937 PMCID: PMC8950387 DOI: 10.3390/healthcare10030459] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Cervical cancer is the fourth most common cancer in women, and it is well known that high-risk human papillomavirus (hrHPV) infections are the necessary carcinogenic factors for the development of cervical tumors. Moreover, the interaction between HPV and other sexually transmitted infections (STIs) may increase the risk of cancer progression. Self-sampling has been demonstrated to represent a valid and well-accepted alternative, favoring women’s participation in screening programs. This study aimed to investigate the use of FLOQSwabs® (FS) as compared to two other vaginal self-collection devices for the detection of hrHPV and other sexually transmitted infections. Methods: Cervical and vaginal self-samples were collected, using two different combinations of vaginal self-sampling devices, from 40 women referred to colposcopy for a documented abnormal Pap smear. All samples were tested for hrHPV and seven STI pathogens using two commercial molecular assays. Results: Data on hrHPV detection from the first group of women showed an almost perfect agreement (kappa: 0.89) between cervical vs. FS vaginal self-samples, and a substantial agreement (kappa: 0.79) between cervical and HerSwab™ (HS) samples. In the second group of women, an almost perfect agreement (kappa: 0.90) was demonstrated in the detection of hrHPV between cervical samples vs. FS, and a moderate agreement (kappa: 0.60) for cervical vs. Evalyn®Brush (EB) self-collected samples. STI detections showed a very good agreement (kappa: 0.89 and kappa: 1.00) both among FS vs. HS and FS vs. EB, respectively. There was no statistically significant difference between the different devices used. The most frequently detected hrHPV genotypes in the studied population were HPV 16, 31, 35, 51, and 56; whilst the most frequently identified STI pathogens were Ureaplasma parvum and Mycoplasma hominis. Overall, investigated women did not report any discomfort in using the different vaginal self-collection devices. Conclusion: Evaluation of the three different vaginal self-collection devices confirmed their overall good acceptability by the studied population, as well as a similar agreement for hrHPV detection as compared to cervical samples. Our study indicated that the use of self-collected samples offers an alternative strategy to improve women’s participation in cervical cancer screening programs, but also underlined the importance of evaluating the concordance in hrHPV detection of collection devices in combination with the molecular hrHPV assay.
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Affiliation(s)
- Illari Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy; (I.S.); (N.M.); (A.P.)
| | - Cocuzza Clementina Elvezia
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore Street, 48, 20900 Milano, Italy;
- Correspondence:
| | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore Street, 48, 20900 Milano, Italy;
| | - Narcisa Muresu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy; (I.S.); (N.M.); (A.P.)
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy;
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy; (I.S.); (N.M.); (A.P.)
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Bober P, Firment P, Sabo J. Diagnostic Test Accuracy of First-Void Urine Human Papillomaviruses for Presence Cervical HPV in Women: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413314. [PMID: 34948919 PMCID: PMC8708158 DOI: 10.3390/ijerph182413314] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 01/07/2023]
Abstract
First-void urine usually contains exfoliated cells of the debris and mucus from the female genital organs and cervix, i.e., high concentration of human papillomavirus deoxyribonucleic acid (HPV DNA). We conducted a meta-analysis of published data and determined an accuracy of HPV detection in first-void urine compared to the women’s cervix. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we carried out a comprehensive literature search. Eligible articles published from 2011 until 2021 were gathered by searching Embase, PubMed and Cochrane Library Central databases. The patient selection, index test, standard test, and patient flow were the factors involved in quality evaluation. A meta-analysis of 15 studies (3412 women) based on 5054 potential records was conducted. Pooled sensitivity for high-risk HPV detection in urine of 78% (70–84%) and specificity of 89% (81–94%) were calculated. Any HPV detection in urine of 87% (74–94%) and 91% (83–96%) were pooled sensitivity and specificity, respectively. HPV 16 and 18 had a pooled sensitivity of 77% (76–77%) and specificity of 98% (98–98%). Meta-analysis indicated variations between the pooled specificities and sensitivities. In meta-regression analysis, a heterogeneity in accuracy by using covariates (bias in patient selection, purpose, sample timing, storage temperature and HPV detection method) were not detected. Our meta-analysis demonstrates the accuracy of detection of HPV in urine for the presence of cervical HPV. Although progress is continuously made in urinary HPV detection, further studies are needed to evaluate and to improve the accuracy of the first-void urine test in order to be comparable with other screening methods.
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Affiliation(s)
- Peter Bober
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P.J. Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia;
- Correspondence:
| | - Peter Firment
- Department of Anaesthesiology and Intensive Medicine, FNsP J. A. Reimana Prešov, Jána Hollého 5898/14, 08181 Prešov, Slovakia;
| | - Ján Sabo
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P.J. Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia;
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Cho HW, Hong JH, Lee JK. Human papillomavirus testing as a primary screening tool for cervical cancer. J Gynecol Oncol 2021; 32:e56. [PMID: 33825364 PMCID: PMC8039169 DOI: 10.3802/jgo.2021.32.e56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hyun Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea.
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Urine HPV in the Context of Genital and Cervical Cancer Screening-An Update of Current Literature. Cancers (Basel) 2021; 13:cancers13071640. [PMID: 33915878 PMCID: PMC8036396 DOI: 10.3390/cancers13071640] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Despite the substantial scientific evolution in cervical cancer prevention and related infrastructures, a plethora of women still miss the opportunity to detect their precancerous lesions at a curable stage by not participating in existing screening programs. Implementing sensitive screening modalities combined with easy sampling methods with minimal pain or discomfort such as self-sampling of vaginal and urine samples is increasingly applied. Self-sampling HPV modalities aimed to address this inequity, besides facilitating HPV genotyping as well as the measurement of related biomarkers in HPV-caused lesions and genital cancer. The low costs inflicted, the non-invasive nature, and the favorable acceptability profile of urine HPV detection give the potential to become a most promising tool that could expand the possibilities in changing genital and cervical cancer prevention strategies as well as in the surveillance and management of genital precancer. Abstract Within the previous decades, following the widespread implementation of HPV-related biomarkers and computerization in liquid-based cytology, screening for lower genital tract malignancies has been optimized in several parts of the world. Many organized anogenital cancer prevention systems have reached a point at which efficacy is more a matter of population coverage and less of available infrastructures. Meanwhile, self-sampling modalities in which biologic material (vaginal secretions, urine, etc.) is obtained by the individual and not the clinician and subsequently undergoes examination for HPV biomarkers enjoy appreciating acceptance. Bygone the initial skepticism that vaginal or urine HPV represents “passenger” transient infections, extensive scientific work has been conducted to optimize high-risk HPV (hrHPV) detection from this “novel” biologic material. Nowadays, several state-of-the-art meta-analyses have illustrated that self-sampling techniques involving urine self-sampling represent a feasible alternative strategy with potentially enhanced population coverage possessing excellent performance and sensitivity. Recently published scientific work focusing on urine HPV was reviewed, and after a critical appraisal, the following points should be considered in the clinical application of hrHPV urine measurements; (i) use of first-void urine (FVU) and purpose-designed collection devices; (ii) using a preservation medium to avoid human/HPV DNA degradation during extraction and storage; (iii) using polymerase chain reaction (PCR) based assays, ideally with genotyping capabilities; (iv) processing of a sufficient volume of whole urine; and (v) the use of an analytically sensitive HPV test/recovery of cell-free HPV DNA in addition to cell-associated DNA.
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