Investigator
Unknown Institution
Accuracy of human papillomavirus testing using self-collected urine samples for detecting high-grade squamous intra-epithelial lesion or worse: a diagnostic meta-analysis
Self-collection methods are regarded as a strategy to promote human papillomavirus (HPV) testing for cervical cancer screening. HPV testing using urine specimens is non-invasive and could eliminate barriers such as embarrassment and discomfort. However, concerns regarding the accuracy of this method persist. Hence, the current meta-analysis aims to verify the accuracy of urine HPV nucleic acid amplification testing. A comprehensive search was conducted in the PubMed, Embase, and Cochrane Library databases to identify studies that evaluated the performance of urine HPV nucleic acid amplification testing. The inclusion criteria were as follows: studies that evaluated the diagnostic accuracy of HPV testing for high-grade squamous intra-epithelial lesion or worse (HSIL+) with self-collected urine specimens. In addition, studies that provided sufficient data for conducting a meta-analysis were assessed. To ensure the rigor of the study, those using histopathology or colposcopy as the reference standard were deemed sufficiently rigorous for inclusion. The meta-analysis was conducted using the bi-variate random-effects model. A total of 21 studies with 6603 samples were identified. The meta-analysis yielded a pooled sensitivity of 83.0% (95% CI 77.5% to 87.3%) and a pooled specificity of 51.3% (95% CI 39.2% to 63.3%) of HPV nucleic acid amplification testing with self-collected urine specimens for HSIL+. In terms of detection technology, a pooled sensitivity of 85.2% and a pooled specificity of 49.4% were obtained from the sub-group analysis of manuscripts that used DNA-based testing. Our meta-analysis indicates that urine HPV nucleic acid amplification testing achieves high sensitivity for detecting HSIL+. A notable benefit of DNA-based urine HPV nucleic acid amplification testing is its heightened sensitivity compared with RNA-based methods.
Accuracy of HPV Testing Using Self-collected Urine Compared With Physician-collected Cervical Specimen for HSIL or Worse
Objectives: Self-collection is a strategy to facilitate HPV testing with the objective of eliminating cervical cancer, as set by the World Health Organization for completion by 2030. Using urine samples for HPV testing offers the advantages of being noninvasive and eliminating barriers to screening. However, concerns remain regarding its accuracy. Therefore, the meta-analysis focused on verifying the comparative effectiveness of HPV testing using self-collected urine specimens versus physician-collected cervical specimens. Methods: A search of PubMed, Embase, and the Cochrane Library databases was conducted to identify studies of HPV testing. The studies incorporated within the current meta-analysis evaluated the diagnostic accuracy of HPV testing for high-grade squamous intraepithelial lesion or worse (HSIL+) with self-collected urine specimens in comparison with physician-collected cervical specimens. Furthermore, studies that offered explicit data to facilitate meta-analysis were also included. The meta-analysis was conducted using a bivariate random-effects model. Results: A total of 23 articles were identified, including 8,332 self-collected urine and 8,324 physician-collected cervical samples. The meta-analysis yielded a pooled sensitivity of 84.5% of HPV testing with self-collected urine specimens, and another meta-analysis yielded a pooled sensitivity of 92.1% of HPV testing with physician-collected cervical specimens for HSIL+. The subgroup analysis revealed that first-void urine with Colli-Pee for evaluating HPV testing reported a pooled sensitivity of 87.8%. Conclusions: HPV testing with physician-collected cervical specimens achieves higher sensitivity for detecting HSIL+ compared with self-collected urine. First-void urine, using a standard collection device, may yield a marginally elevated level of sensitivity.
