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Aimagambetova G, Atageldiyeva K, Marat A, Suleimenova A, Issa T, Raman S, Huang T, Ashimkhanova A, Aron S, Dongo A, Iztleuov Y, Shamkeeva S, Azizan A. Comparison of diagnostic accuracy and acceptability of self-sampling devices for human Papillomavirus detection: A systematic review. Prev Med Rep 2024; 38:102590. [PMID: 38283967 PMCID: PMC10821625 DOI: 10.1016/j.pmedr.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/28/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Objective Cervical cancer screening coverage remains low in many countries worldwide. Self-sampling approach for cervical cancer screening has a good potential to improve the screening coverage. This study aims to compare different types of HPV self-sampling devices for cervical cancer screening to identify the most accurate and acceptable device(s). Methods A systematic review was performed on data extracted from all studies specific to HPV self-sampling devices by searching relevant articles in PubMed, Google Scholar, Scopus, Web of Science, ScienceDirect, Cochrane Library, and EBSCO published from 2013 to October 2023. The study was registered in PROSPERO (CRD42022375682). Results Overall, 70 papers met the eligibility criteria for this systematic review and were included in the analysis: 22 studies reported self-sampling devices diagnostic accuracy, 32 studies reported self-sampling devices acceptability and 16 studies reported both (accuracy and acceptability). The most popular self-sampling devices were Evalyn Brush, FLOQ Swab, Cervex-Brush, and Delphi Screener. Out of overall 38 studies analyzing self-sampling devices' diagnostic accuracy, 94.7% of studies reported that self-collected specimens provided sensitivity and specificity comparable with clinician-collected samples; acceptability of Evalyn Brush, FLOQ Swab, Delphi Screener, and Colli-Pee, varied between 84.2% and 100%. Conclusion The self-sampling approach has a good potential to increase cervical cancer screening coverage. Evalyn Brush, Cervex-Brush, FLOQ Swab, and Delphi Screener self-sampling devices for HPV detection were the most commonly utilized and found to be the most accurate, and patient-acceptable. HPV detection accuracy using these self-sampling devices had no significant difference compared to the sampling performed by healthcare providers.
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Affiliation(s)
- Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF “University Medical Center”, 10000 Astana, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC “Astana Medical University”, 010000, Astana, Kazakhstan
| | - Assem Suleimenova
- Kazakh National Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Torgyn Issa
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Sarina Raman
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Timothy Huang
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Ayimkul Ashimkhanova
- Department of Medicine, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
- Department of Clinical Medicine, School of Medicine, Al Farabi University, Almaty, Kazakhstan
| | - Saida Aron
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Andrew Dongo
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Yerbolat Iztleuov
- Medical Center, Marat Ospanov West-Kazakhstan Medical University, 030000, Aktobe, Kazakhstan
| | - Saykal Shamkeeva
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University Hospital, 04103, Leipzig, Germany
| | - Azliyati Azizan
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
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Lichtenfels M, Lorenzi NPC, Tacla M, Yokochi K, Frustockl F, Silva CA, Silva ALD, Termini L, Farias CB. A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:235-241. [PMID: 37339642 PMCID: PMC10281768 DOI: 10.1055/s-0043-1770134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. METHODS A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. RESULTS HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. CONCLUSION Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.
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Affiliation(s)
| | | | - Maricy Tacla
- Department of Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Kaori Yokochi
- Department of Gynecology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | | | - André Luiz da Silva
- Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lara Termini
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Hassine A, Antoni G, Fender M, Slama K, Léandri FX, Fanon JL, Auvray C, Jaffar Bandjee MC, Traversier N, Fagour L, Rochaix L, Fiorina C, Pourette D, Opigez E, Dumont A, Bardou M, Study Group R. Combined incentive actions, focusing on primary care professionals, to improve cervical cancer screening in women living in socioeconomically disadvantaged geographical areas: a study protocol of a hybrid cluster randomised effectiveness and implementation trial- RESISTE. BMJ Open 2022; 12:e065952. [PMID: 36418118 PMCID: PMC9684961 DOI: 10.1136/bmjopen-2022-065952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cervical cancer (CC) causes thousands of deaths each year. Nearly 100% of cases are caused by oncogenic strains of human papillomavirus (HPV). In most industrialised countries, CC screening (CCS) is based on the detection of HPV infections. For many reasons including lower adherence to CCS, underserved women are more likely to develop CC, and die from it. We aim to demonstrate that the use of incentives could improve screening rates among this population. METHODS AND ANALYSIS Our cluster randomised, controlled trial will include 10 000 women aged 30-65 years eligible for CCS, living in deprived areas in four French departments, two mainlands and two overseas, and who did not perform physician-based HPV testing within the framework of the nationally organised screening programme. HPV self-sampling kit (HPVss) will be mailed to them. Two interventions are combined in a factorial analysis design ending in four arms: the possibility to receive or not a financial incentive of €20 and to send back the self-sampling by mail or to give it to a health professional, family doctor, gynaecologist, midwife or pharmacist. The main outcome is the proportion of women returning the HPVss, or doing a physician-based HPV or pap-smear test the year after receiving the HPVss. 12-month follow-up data will be collected through the French National Health Insurance database. We expect to increase the return rate of HPV self-samples by at least 10% (from 20% to 30%) compared with the postal return without economic incentive. ETHICS AND DISSEMINATION Ethics approval was first obtained on 2 April 2020, then on July 29 2022. The ethics committee classified the study as interventional with low risk, thus no formal consent is required for inclusion. The use of health insurance data was approved by the Commission Nationale Informatique et Libertés on 14 September 2021 (ref No 920276). An independent data security and monitoring committee was established. The main trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04312178.
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Affiliation(s)
- Amir Hassine
- CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Guillemette Antoni
- Centre for Research in Epidemiology and Population Health INSERM UMR 1018, CESP, Villejuif, France
| | - Muriel Fender
- Regional Center for the Coordination of Cancer Screening Grand Est Region, Strasbourg, France
| | - Katia Slama
- Regional Screening for the Coordination of Cancer Screening, Réunion, France
| | - François-Xavier Léandri
- Regional Center for the Coordination Screening of Cancer Screening PACA Region, Marseille, France
| | - Jean-Luc Fanon
- Regional Centre for the Coordination of Cancer Screening Martinique Island, Martinique, France
| | | | | | | | - Laurence Fagour
- Laboratory of Virology, CHU de Martinique, Fort-de-France, Martinique
| | - Lise Rochaix
- Chaire de Recherche Hospinnomics, Paris School of Economics, Paris, France
| | - Camilla Fiorina
- Chaire de Recherche Hospinnomics, Paris School of Economics, Paris, France
| | | | | | | | - Marc Bardou
- CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Resiste Study Group
- Regional Center for the Coordination of Cancer Screening Grand Est Region, Strasbourg, France
- Regional Screening for the Coordination of Cancer Screening, Réunion, France
- Regional Center for the Coordination Screening of Cancer Screening PACA Region, Marseille, France
- Regional Centre for the Coordination of Cancer Screening Martinique Island, Martinique, France
- CEPED, Research Institute for Development, Paris, France
- DRCI, CHU Félix Guyon, Saint-Denis, Réunion
- Centre Hospitalier Universitaire de Dijon, Dijon, France
- DRCI, Pierre Zobda-Quitman Hospital, Martinique, France
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Belkić K, Andersson S, Alder S, Mints M, Megyessi D. Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow‑up. Oncol Lett 2022; 24:357. [PMID: 36168314 PMCID: PMC9478621 DOI: 10.3892/ol.2022.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of adenocarcinoma-in-situ (AIS) of the uterine cervix is rising, with invasive adenocarcinoma becoming increasingly common relative to squamous cell carcinoma. The present study reviewed a cohort of 84 patients first-time treated by conization for histologically-confirmed AIS from January 2001 to January 2017, to identify risk factors associated with recurrent/persistent AIS as well as progression to invasive cervical cancer. Nearly 80% of the patients were age 40 or younger at conization. Endocervical and ectocervical margins were deemed clear in 42 of the patients. All but two patients had ≥1 follow-up, with post-conization high-risk human papilloma virus (HPV) results documented in 52 patients. Altogether, 12 histopathologically-confirmed recurrences (14.3%) were detected; two of these patients had microinvasive or invasive carcinoma. In three other patients cytology showed AIS, but without recorded histopathology. Eight patients underwent hysterectomy for incomplete resection very soon after primary conization; they were not included in bivariate or multivariate analyses. Having ≥1 post-follow-up positive HPV finding yielded the highest sensitivity for histologically-confirmed recurrence: 87.5 [95% confidence interval (CI) 47.4-99.7]. Current or historical smoking status provided highest specificity: 94.4 (95% CI 72.7-99.9) and overall accuracy: 88.0 (95% CI 68.8-97.5) for histologically-confirmed recurrence. With multiple logistic regression (MLR), adjusting for age at conization and abnormal follow-up cytology, positive HPV18 was the strongest predictor of histologically-confirmed recurrence (P<0.005). Having ≥2 positive HPV results also predicted recurrence (P<0.02). Any unclear margin yielded an odds ratio 7.21 (95% CI 1.34-38.7) for histologically-confirmed recurrence adjusting for age, but became non-significant when including abnormal cytology in the MLR model. The strong predictive value of HPV, particularly HPV18 and persistent HPV positivity vis-à-vis detected recurrence indicated that regular HPV testing for patients treated for AIS is imperative. In conclusion, furthering a participatory approach, including attention to smoking with encouragement to attend needed long-term follow-up, can better protect these patients at high risk for cervical cancer.
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Affiliation(s)
- Karen Belkić
- Department of Oncology‑Pathology, Karolinska Institute, SE‑17176 Stockholm, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
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Dieleman M, de Waard J, Wisman GBA, Schuuring E, Esajas MD, Vermeulen KM, de Bock GH. Preferences and Experiences Regarding the Use of the Self-Sampling Device in hrHPV Screening for Cervical Cancer. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:245-253. [PMID: 34558035 PMCID: PMC8866331 DOI: 10.1007/s40271-021-00550-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND To improve participation in the Dutch cervical cancer screening, a self-sampling device (SSD) was introduced in 2017 into the Dutch population-based screening programme (PBS) for the early detection of cervical cancer. The aim of this study was to gather potential preferences and experiences that might influence a woman's decision to use the SSD in the Dutch PBS. METHODS A scoping review was performed in the PubMed database. Studies that assessed preferences and experiences of women regarding the SSD were included, and preferences and experiences were extracted. In addition, in a qualitative study, the list of potential preferences and experiences specific for the Dutch PBS was extended based on semi-structured interviews with SSD users as well as non-SSD users who recently participated in the PBS, analysed in a structured manner by translating full sentences to key words. RESULTS Ninety-eight studies were included in the scoping review and 16 interviews were performed. Frequently mentioned reasons for using the SSD, in both the interviews and the literature, were practicality and comfort. Frequently mentioned reasons for not using the SSD were fear of not performing the SSD procedure correctly and doubts on whether the results of the high-risk human papillomavirus (hrHPV) test will be reliable. A new positive experience elicited in the interviews was accessibility. Negative preferences and experiences were not being aware the SSD was an option, and the inconvenience that after an hrHPV-positive test result of the SSD, an additional smear test at the GP is necessary. CONCLUSION Several preferences and experiences play a role in the choice whether or not to use the SSD. Based on the currently found preferences and experiences, an app will be developed in order to assess which of these are the most important for women participating in the Dutch population-based cervical screening programme.
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Affiliation(s)
- Marjolein Dieleman
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Huispostcode FA40, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Jolien de Waard
- Department of Gynaecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - G Bea A Wisman
- Department of Gynaecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ed Schuuring
- Department of Pathology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Martha D Esajas
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Huispostcode FA40, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Huispostcode FA40, PO BOX 30 001, 9700 RB, Groningen, The Netherlands.
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Andersson S, Megyessi D, Belkić K, Alder S, Östensson E, Mints M. Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment. Oncol Lett 2021; 22:684. [PMID: 34434283 PMCID: PMC8335741 DOI: 10.3892/ol.2021.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4–6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3–9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0–14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0–16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4–11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.
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Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.,Institute for Health Promotion & Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebrö, Sweden
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Ørnskov D, Jochumsen K, Steiner PH, Grunnet IM, Lykkebo AW, Waldstrøm M. Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study. BMJ Open 2021; 11:e041512. [PMID: 33674367 PMCID: PMC7939007 DOI: 10.1136/bmjopen-2020-041512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To increase effectiveness of the cervical cancer screening program, self-sampling can be an option. Both self-collected vaginal samples (SCV) and urine samples may be useful alternatives to clinician-taken cervical samples (CS). DESIGN Cross-sectional study. SETTING Colposcopy clinic. PARTICIPANTS Women (n=305) referred to colposcopy after abnormal cervical screening result or conditions like postcoital bleeding. INTERVENTION All women self-collected a urine and a vaginal sample prior to colposcopy, where a CS and biopsies were taken. All samples were tested for high-risk human papillomavirus (HPV) using the Cobas HPV assay. The gold standard was histology diagnoses (CIN2+/CIN3+) from biopsies obtained at the same examination. PRIMARY OUTCOME Absolute and relative sensitivity and specificity of HPV testing on SCV and urine to detect CIN2+/CIN3+ compared with the CS. SECONDARY OUTCOME The acceptability by women of self-sampling. RESULTS Both the vaginal and urine sample were comparable to the CS in identifying severe intraepithelial neoplasia (CIN2+/CIN3+). Absolute sensitivity ranged from 93% for urine samples to 96% for SCV for detecting CIN2+, which is comparable to the sensitivity of CS (overlapping 95% CI).The relative sensitivity for detecting CIN2+ was 1.00 (95% CI 0.96 to 1.04) for SCV and 0.96 (95% CI 0.91 to 1.03) for urine samples. At CIN3+, the relative sensitivity was 1.00 (95% CI 0.96 to 1.08) and 0.97 (95% CI 0.89 to 1.07) for SCV and urine samples, respectively. There were no statistical differences between the self-collected samples and the CS (McNemar's test >0.05). The relative specificity was also similar (1.03 (95% CI 0.95 to 1.12) for SCV and 0.98 (95% CI 0.89 to 1.09) for urine samples) (McNemar's test >0.05).The acceptability of self-sampling was evaluated by questionnaire. The women found the instructions on sample collection easy to understand and were positive about self-sampling with a preference for the urine sample. CONCLUSION Self-sampling by SCV and urine is a clinically safe alternative to CS with a high degree of acceptability.
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Affiliation(s)
- Dorthe Ørnskov
- Clinical Pathology, Sygehus Lillebalt Vejle Sygehus, Vejle, Denmark
| | - Kirsten Jochumsen
- Department of Gynecology, Odense University Hospital, Odense, Denmark
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Östensson E, Belkić K, Ramqvist T, Mints M, Andersson S. Self-sampling for high-risk human papillomavirus as a follow-up alternative after treatment of high-grade cervical intraepithelial neoplasia. Oncol Lett 2021; 21:240. [PMID: 33664804 PMCID: PMC7884875 DOI: 10.3892/ol.2021.12501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 01/19/2023] Open
Abstract
Women treated for high-grade cervical-intraepithelial-neoplasia (CIN) require long-term follow-up with high-risk human-papillomavirus (HPV) testing. Self-sampling for HPV is well-accepted among these patients, but its role in follow-up for this group requires investigation. The present study examined how well HPV findings from self-sampled vaginal (VSS) and urine specimens correctly identified women from this cohort with recurrent CIN2+ compared with samples collected by clinicians. At 1st post-conization follow-up, 531 patients (99.8% participation) gave urine samples, performed VSS, underwent colposcopy with punch biopsy of visible lesions and clinician-collected cervical sampling for HPV analysis and liquid-based cytology. A total of 113 patients with positive HPV and/or abnormal cytology at 1st follow-up underwent 2nd follow-up. At 1st follow-up, all patients with recurrent CIN3 had positive HPV results by all methods. Clinician sampling and VSS revealed HPV16 positivity in 50% of recurrent cases and urine sampling revealed HPV16 positivity in 25% of recurrent cases. At 2nd follow-up, all 7 newly-detected CIN2/3 recurrences were associated with HPV positivity on VSS and clinician-samples. Only clinician-collected samples detected HPV positivity for two adenocarcinoma-in-situ recurrences, and both were HPV18 positive. A total of 77 patients had abnormal cytology at 1st follow-up, for which HPV positivity via VSS yielded highest sensitivity. The HPV findings were positive from VSS in 12 patients with high-grade squamous-intraepithelial-lesions (HSIL), and 11 patients with HSIL had positive HPV findings in clinician-collected and urine samples. All methods for assessing HPV presence yielded significant age-adjusted odds ratios for predicting abnormal lesions at 1st follow-up. For overall HPV results, Cohen's kappa revealed substantial agreement between VSS and clinician sampling, and moderate agreement between urine and clinician sampling. Clinician sampling and VSS were highly concordant for HPV16. Insofar as the pathology was squamous (not glandular), VSS appeared as sensitive as clinician sampling for HPV in predicting outcome among the present cohort. Since VSS can be performed at home, this option can maximize participation in the required long-term follow-up for these women at high-risk.
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Affiliation(s)
- Ellinor Östensson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.,Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebro, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
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