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

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?