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Grand Rounds

Urine Samples to Detect HPV?

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BACKGROUND AND PURPOSE:

  • Cervical cancer screening using self-sampling may reduce barriers and improve uptake among those women who do not routinely see healthcare providers
  • Sargent et al. (BMJ Open, 2019) aimed to
    • Optimize urine testing for HPV detection
    • Determine concordance for HR-HPV detection in matched urine, vaginal and cervical samples
    • Compare the sensitivity of HR-HPV testing for the detection of CIN2+ with other methods
    • Determine the acceptability of urine testing for cervical screening

METHODS:

  • Cross-sectional study
  • Participants
    • Women ≥25 years
    • Abnormal cervical screening results or a suspicious-looking cervix
  • Sample collection
    • Consecutive patients in colposcopy unit
    • Urine, vaginal (self-collected) and cervical samples (practitioner obtained via cervical brush)
    • HR-HPV testing: Abbott RealTime and Roche Cobas assays, with and without urine preservative
    • No change in patient care with respect to colposcopy and directed biopsies
    • The acceptability of self-testing was evaluated by questionnaire
  • Primary outcome
    • Sensitivity of urine to detect underlying CIN2+
  • Secondary outcomes
    • Comparative sensitivity of vaginal and cervical samples to detect CIN2+
    • The acceptability of urine sampling

RESULTS:

  • 104 women participated in the study
    • 40% were between 25 and 29 years
  • Preservative-fixed urine showed good concordance with vaginal samples for the detection of HR-HPV, while urine samples without preservative fixation did not
  • Sensitivity for detecting CIN2+ (n=21)
    • Urine with RealTime : 83% (15/18)
    • Cervical and vaginal by RealTime: Both were 16/18 (89%)
    • All samples by RC: 15/17 (88%)
  • 98 women responded to questionnaire
    • Urine based testing was acceptable to women
    • More confident regarding obtaining the urine sample compared to the vaginal sample

CONCLUSION:

  • HR-HPV detection through urine self-collection offers a potential alternative strategy for cervical screening that women found broadly acceptable
  • There was good concordance between urine, vaginal and cervical samples
    • Urine was “slightly inferior” to vaginal (also self-collected) and cervical samples (practioner collected) for CIN2+
  • Larger cohorts needed to validate these findings
  • Larger studies are recommended to determine clinical utility

Learn More – Primary Sources:

Cross-sectional study of HPV testing in self-sampled urine and comparison with matched vaginal and cervical samples in women attending colposcopy for the management of abnormal cervical screening

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Related ObG Topics:

Guidance Update: Professional Organizations Align on Cervical Cancer Screening
HPV Testing vs PAP Smear: Results of the HPV FOCAL Trial
Does HPV Testing in the Setting of ASC-US Impact Long Term Outcomes?
How Frequently Should We Re-Screen Following a Negative HPV result?

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