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Comparative performance of HPV self-sampling and conventional screening methods: A systematic review and bivariate
Ruhi Dixit1, Ankita Chakrawal1, Roli Purwar2
1Health Technology Assessment India (HTAIn) resource center, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
Gynecologic Oncology
|May 30, 2026
Summary
Human papillomavirus (HPV) self-sampling offers a robust alternative for cervical cancer screening, significantly outperforming Visual Inspection with Acetic Acid (VIA) and showing substantial agreement with clinician-collected samples. This strategy is key for expanding prevention in underserved areas.
Area of Science:
- Gynecology
- Public Health
- Oncology
Background:
- Cervical cancer poses a significant global health burden, particularly in resource-limited settings with inadequate screening coverage.
- Human papillomavirus (HPV) self-sampling (SS) presents a promising approach to overcome logistical challenges in cervical cancer screening.
- The diagnostic accuracy of HPV SS compared to clinician-collected (CC) sampling, Visual Inspection with Acetic Acid (VIA), and Papanicolaou (Pap) cytology requires thorough validation.
Purpose of the Study:
- To systematically evaluate the diagnostic accuracy of HPV self-sampling against established cervical cancer screening methods.
- To compare HPV SS performance with clinician-collected (CC) sampling, VIA, and Pap cytology using biopsy-confirmed CIN2+ as the reference standard.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA-DTA guidelines was conducted, searching major databases through March 2025.
- Studies comparing high-risk HPV SS with CC, VIA, or Pap cytology were included, with biopsy-confirmed CIN2+ as the gold standard.
- Bivariate random-effects models and HSROC curves were used to pool sensitivity, specificity, and assess publication bias.
Main Results:
- Thirty-one studies encompassing 98,346 women were analyzed.
- HPV SS demonstrated pooled sensitivity of 0.745 and specificity of 0.850, comparable to CC sampling (Sensitivity: 0.886, Specificity: 0.870).
- HPV SS significantly outperformed VIA (Sensitivity: 0.646 vs. 0.536) and Pap cytology (Sensitivity: 0.74 vs. 0.67), with brush-based samplers showing the highest sensitivity (0.78).
Conclusions:
- HPV self-sampling is a viable and effective alternative to traditional screening methods, particularly outperforming VIA.
- The substantial agreement between HPV SS and CC sampling supports its implementation as a primary strategy for cervical cancer prevention.
- Self-sampling holds significant potential for expanding cervical cancer prevention efforts in underserved populations.
