FPIN's Clinical Inquiries

Screening for Cervical Intraepithelial Neoplasia with Patient-Collected HPV Samples

 

Am Fam Physician. 2021 Feb 1;103(3):181-182.

Clinical Question

How useful are patient-collected human papillomavirus (HPV) vaginal swabs as a screening test for cervical intraepithelial neoplasia (CIN)?

Evidence-Based Answer

Self-collected vaginal swabs using polymerase chain reaction (PCR) for HPV are equal to clinician-collected cytology and HPV swabs for detection of CIN2 or greater (99% sensitive and 98% specific). Signal amplification testing is less sensitive (85%) for diagnosis of CIN2 or CIN3 by self-collection, although similarly specific (96% to 97%). (Strength of Recommendation [SOR]: A, based on a large meta-analysis of accuracy tests performed in Africa, China, India, and Nicaragua, and a large randomized controlled trial in the Netherlands.) Mailing self-collection kits to women produces twice the participation rate compared with clinic visits, is well-accepted, and is preferred by 59% of patients. (SOR: A, based on meta-analyses.)

Evidence Summary

A 2014 meta-analysis of 36 accuracy studies (N = 154,556 women) with a recent 2018 update of 20 additional studies (additional total N not reported) comparing self-collected HPV samples to clinician-collected samples (HPV and cytology) for the diagnosis of CIN2/3 found equal sensitivity with PCR testing.1,2 The authors collected accuracy studies with a minimum of 400 women and evaluated the sensitivity of diagnosis of HPV infection and CIN, comparing point-of-care HPV DNA tests with self-collected cervical swabs against a diagnostic standard of clinician-collected HPV testing and cytology. The authors included studies with the following criteria: high-risk HPV testing performed on both self-collected and clinician-collected samples, or microscopic examination of the clinician-collected sample. Researchers verified the presence or absence of CIN2+ (or CIN3+) by colposcopy and biopsy in all enrolled women or in women with at least one positive initial test. Trials included patients in five African countries, regions of China and India, and Nicaragua. PCR testing was equally sensitive

Address correspondence to Gary Kelsberg, MD, at kelsberg@uw.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


Copyright © Family Physicians Inquiries Network. Used with permission.

References

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1. Arbyn M, Verdoodt F, Snijders PJF, et al. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol. 2014;15(2):172–183....

2. Arbyn M, Smith SB, Temin S, et al.; Collaboration on Self-Sampling and HPV Testing. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ. 2018;363:k4823.

3. Kelly H, Mayaud P, Segondy M, et al. A systematic review and meta-analysis of studies evaluating the performance of point-of-care tests for human papillomavirus screening. Sex Transm Infect. 2017;93(S4):S36–S45.

4. Polman NJ, Ebisch RMF, Heideman DAM, et al. Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: a randomised, paired screen-positive, non-inferiority trial. Lancet Oncol. 2019;20(2):229–238.

5. Nelson EJ, Maynard BR, Loux T, et al. The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis. Sex Transm Infect. 2017;93(1):56–61.

6. Pedersen HN, Smith LW, Sarai Racey C, et al. Implementation considerations using HPV self-collection to reach women under-screened for cervical cancer in high-income settings. Curr Oncol. 2018;25(1):e4–e7.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

 

 

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