Review
Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis

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Abstract

Objective.

To compare the detection rate of genital human papillomavirus (HPV) infection in self- and physician-obtained samples.

Design.

Systematic review and meta-analysis.

Data sources.

Studies published between 1966 and November 2005 identified through Medline and Embase that compared both sampling methods.

Main outcome measures.

We calculated the concordance and kappa statistic between physician- and self-sampling and the difference between proportions of HPV positive samples. Weighted averages were reported with 95% confidence intervals (CI) using a random-effects model.

Results.

Eighteen studies (5441 participants) were included that evaluated broad HPV type categories, 10 (3688 patients) that of high-risk (HR) HPV and three (530) that of low-risk (LR) HPV. A high level of concordance of 0.87 (95%CI, 0.82 to 0.91) between self- and physician-sampling was obtained for detection of HPV DNA (kappa 0.66, 95%CI, 0.56 to 0.76). The prevalence difference of HPV DNA between sampling methods was − 0.5 (95%CI, − 2.8 to 1.8). Results were similar when restricting the analysis to HR-HPV but the prevalence of LR-HPV types was higher in self-collected samples.

Conclusion.

Self-sampling was as sensitive as physician-obtained sampling to detect HR-HPV or HPV DNA. Self-sampling may be a suitable alternative method for studies on HPV transmission and vaccine trials.

Introduction

Human papillomavirus (HPV) is now well established as the necessary cause of cervical cancer [1]. Implementation of efficient strategies to study, prevent and control HPV genital tract infection, including vaccination, requires a simple and easy method for HPV detection [2]. Self-sampling has several advantages compared with physician-collected samples for detection of HPV genital infection. Self-sampling is a less costly and non-invasive collection procedure. Self-collected samples can be more easily obtained in settings with limited resources or in populations difficult to reach. Numerous studies have reported lately that self-obtained samples of the anogenital tract in women were accurate and suitable for DNA testing [3], [4], [5], [6], [7]. Currently, there is no consensus on which sampling method is the most effective for HPV DNA testing. However, a sample collected by a health care professional during a speculum examination is generally considered as the “gold standard”.

In 2005, a meta-analysis of 12 studies revealed that self-sampling had a sensitivity ≥ 70% and a specificity of 88% compared to physician-sampling to detect the presence of HPV infection [8]. However, the authors did not discriminate between results obtained with high-risk (HR) and low-risk (LR) HPV types. The prevalence of LR- and HR-HPV types depends on grade of anogenital disease and sampling site. Since the publication of that meta-analysis, relevant studies comparing self- versus physician-obtained sampling have been published [3], [9], [10].

The aim of this systematic review was to update the previously published meta-analysis, by including all available relevant epidemiological studies on the accuracy of self- and physician-obtained samples to identify women infected by HPV in the anogenital tract. We focused on detectability as the outcome of interest, i.e., any positive test, whether originating from self- or from physician-sampling. Our intent was on virological detection only, not on comparing collection methods as per their ability to distinguish HPV testing performances for detecting cervical precancerous lesions.

Section snippets

Search strategy

A systematic literature search of MEDLINE from 1966 through November 2005 and of EMBASE from 1990 through November 2005 was conducted without language restriction entering “human papillomavirus” or “HPV” and “self-” or “patient-” or “auto-” or “physician-” or “clinician-” or “health professional-” combined with “collection” or “obtained” or “sampling” or “testing” as both medical subject heading (MeSH) terms and text words. In addition, bibliographies of studies referenced in a previous

Literature search and study selection

Of the 450 reports that were screened, 66 were relevant for the current study. Reasons for exclusion of 48 of these studies included: absence of comparison with a physician-obtained sample or evaluation of the acceptability of self-sampling only (n = 43), lack of frequency data to construct 2 × 2 tables (n = 4) [12], [13], [14], [15], and duplication of previously published data (n = 1) [16]. The remaining informative 18 reports (5441 participants) were published between 1992 and November 2005 (Table 1

Discussion

In this systematic review, the overall detection of HPV genital infection irrespective of HPV type category was equivalent for self-and physician-obtained samples. Although the presence of lesions may modify the ability to detect HPV, the agreement between self- and physician-obtained samplings was good regardless of the disease prevalence in the tested population. As LR-HPV infect more often the vagina and vulva than HR-HPV, they may be more easily collected by self-sampling and explain the

Acknowledgments

We thank Dr Felippe Lorenzato and Dr Diane Harper for contributing additional data from their studies.

References (28)

  • P. Petignat et al.

    Self-sampling is associated with increased detection of human papillomavirus DNA in the genital tract of HIV-seropositive women

    Clin. Infect. Dis.

    (2005)
  • D.M. Harper et al.

    Tampon samplings with longer cervicovaginal cell exposures are equivalent to two consecutive swabs for the detection of high-risk human papillomavirus

    Sex Transm. Dis.

    (2002)
  • T.C. Wright et al.

    HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer

    JAMA

    (2000)
  • F. Coutlee et al.

    Comparison between vaginal tampon and cervicovaginal lavage specimen collection for detection of human papillomavirus DNA by the polymerase chain reaction

    J. Med. Virol.

    (1997)
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