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Published on: June 14, 2019
Self-collected versus clinician-collected samples for HPV testing: A meta-analysis revealing lower sensitivity for
Gabriel Gonçalves Santiago Lima1, Annielson de Souza Costa1, Mayara Souza Alves1
1Gynecology Discipline, Department of Obstetrics and Gynecology, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil.
Objective:
To compare the specificity and sensitivity between self-collection and collection performed by healthcare professionals in testing High-risk oncogenic Human Papillomavirus (HrHPV) to detect high-grade uterine cervical lesions.
Methods:
A systematic review was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Meta-analysis was conducted on STATA-14SE using random effects models for the aggregated values of sensitivity and specificity of studies that evaluated self-collection and collection by healthcare professionals. This review is registered on PROSPERO under CRD42022347731.
Results:
This study included 17 articles. Regarding the sensitivity of the collection method, self-collection was superior to professional collection in 2 studies, inferior in 8, equivalent in 1, and variable depending on the sample storage medium, HPV DNA analysis method, or CIN grade assessed in 3. The specificity between the methods was higher with self-collection in 5 studies, lower in 5 others, equivalent in 1, not evaluated in 1, and variable depending on the HPV DNA detection method in 2 articles. The results of the meta-analysis of studies that evaluated the sensitivity and specificity of devices used for HPV detection between self-collection and health-professionals collection showed significant differences of sensitivity favorable to the health-professionals (SMD = -0.540; 95% CI -0.595 ‒ -0.486; p < 0.001). The evaluation of the sensitivity and specificity of the type of lesion between self-collection and health professionals' collection showed significant differences in sensitivity, favorable to the health professionals (SMD = -0.872; 95% CI -1.392 ‒ -0.351; p = 0.001).
Conclusion:
In conclusion, while specificity is comparable, this meta-analysis demonstrates that self-collected samples have significantly lower sensitivity for detecting HR-HPV and high-grade cervical lesions compared to clinician-collected samples. This suggests that self-sampling, in its current form, may be best utilized with complementary triage strategies or in settings where its logistical advantages outweigh the modest reduction in sensitivity for increasing screening coverage.
