Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Rebecca Landy¹  Tony Hollingworth²  Jo Waller³  Laura AV Marlow³  Jane Rigney³  Thomas Round⁴  Peter D Sasieni³  Anita WW Lim³ 

[1] Division of Cancer Epidemiology and Genetics, National Cancer Institute;Whipps Cross University Hospital;School of Cancer and Pharmaceutical Sciences, King’s College London;School of Population Health and Environmental Sciences, King’s College London

关键词: alphapapillomavirus;    cervical cancer screening;    cervical intraepithelial neoplasia;    diagnostic accuracy;    general practice;    self-sampling;   

DOI  :  10.3399/BJGP.2021.0708

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Cervical cancer incidence and mortality are high in women aged ≥65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause.Aim To examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum).Design and setting Cross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019.Method Non-speculum and conventional (speculum) samples were collected from women aged ≥50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged ≥35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50–64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening).Results The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% confidence interval [CI] = 60.8 to 94.2) (n = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample ≤91 days prior to the non-speculum sample (n = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4% (95% CI = 92.7 to 98.5), with 96.6% concordant results (κ 72.4%). Seventy-one percent (n = 120/170) of women preferred a non-speculum sample for their next screen.Conclusion HPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.

【 授权许可】

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