Screening for Cervical Intraepithelial Neoplasia with Patient-Collected HPV Samples.

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Date: Feb. 1, 2021
From: American Family Physician(Vol. 103, Issue 3)
Publisher: American Academy of Family Physicians
Document Type: Article
Length: 1,126 words
Lexile Measure: 1390L

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Clinical Question

How useful are patient-collected human papillomavirus (HPV) vaginal swabs as a screening test for cervical intraepithelial neoplasia (CIN)?

Evidence-Based Answer

Self-collected vaginal swabs using polymerase chain reaction (PCR) for HPV are equal to clinician-collected cytology and HPV swabs for detection of CIN2 or greater (99% sensitive and 98% specific). Signal amplification testing is less sensitive (85%) for diagnosis of CIN2 or CIN3 by self-collection, although similarly specific (96% to 97%). (Strength of Recommendation [SOR]: A, based on a large meta-analysis of accuracy tests performed in Africa, China, India, and Nicaragua, and a large randomized controlled trial in the Netherlands.) Mailing self-collection kits to women produces twice the participation rate compared with clinic visits, is well-accepted, and is preferred by 59% of patients. (SOR: A, based on meta-analyses.)

Evidence Summary

A 2014 meta-analysis of 36 accuracy studies (N = 154,556 women) with a recent 2018 update of 20 additional studies (additional total N not reported) comparing self-collected HPV samples to clinician-collected samples (HPV and cytology) for the diagnosis of CIN2/3 found equal sensitivity with PCR testing. (1,2) The authors collected accuracy studies with a minimum of 400 women and evaluated the sensitivity of diagnosis of HPV infection and CIN, comparing point-of-care HPV DNA tests with self-collected cervical swabs against a diagnostic standard of clinician-collected HPV testing and cytology. The authors included studies with the following criteria: high-risk HPV testing performed on both self-collected and clinician-collected samples, or microscopic examination of the clinician-collected sample. Researchers verified the presence or absence of CIN2+ (or CIN3+) by colposcopy and biopsy in all enrolled women or in women with at least one positive initial test. Trials included patients in five African countries, regions of...

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Gale Document Number: GALE|A648962589