HPV Testing in Self-Collected Samples Has High Sensitivity

Home-HPV testing is more sensitive than cervical cytology, but has lower positive predictive value

WEDNESDAY, Nov. 2 (HealthDay News) -- Human papillomavirus (HPV) DNA testing of self-collected vaginal specimens is more sensitive than clinic-based cervical cytology for detection of cervical cancer and cervical intraepithelial neoplasia (CIN) grade 2 or worse, but has lower positive predictive value, according to a study published online Nov. 3 in The Lancet.

Eduardo Lazcano-Ponce, Ph.D., from the Instituto Nacional de Salud Pública in Cuernavaca, Mexico, and colleagues compared the sensitivity and positive-predictive value for HPV screening of vaginal specimens self-collected at home versus clinic-based cervical cytology testing in 25,061 women from 540 medically underserved communities. Detection of CIN grade 2 or worse by colposcopy was the primary end point. A computer-generated randomization sequence allocated patients to HPV screening (12,330 women) or cervical cytology (12,731 women).

The investigators found that 9,202 and 11,054 women undergoing HPV screening and cervical cytology, respectively, adhered to the protocol. The prevalence of HPV was 9.8 percent, and the rate of abnormal cytology was 0.38 percent. HPV testing identified 117.4 women per 10,000 with CIN 2 or worse, versus 34.4 women per 10,000 identified with cytology, indicating 3.4 times greater relative sensitivity for HPV testing. Detection of invasive cancers was 4.2 times more with HPV testing than cytology (30.4 per 10,000 versus 7.2 per 10,000). The positive predictive value for CIN 2 or worse was 12.2 percent for HPV testing, versus 90.5 percent for cytology.

"Despite the much lower positive predictive value for HPV testing of self-collected vaginal specimens compared with cytology, such testing might be preferred for detecting CIN 2 or worse in low-resource settings," the authors write.

One of the study authors disclosed financial ties to QiAGEN, which partially funded the study and manufactures the Hybrid Capture 2 HPV test.

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