title: High concordance of results of testing for human papillomavirus in cervicovaginal samples collected by two methods, with comparison of a novel self-sampling device to a conventional endocervical brush.
abstract: A user-friendly self-sampling method for collecting representative cervical cell material would lower the threshold for women to respond to the invitation for cervical screening. In the present article, we introduce such a device; we have evaluated its sensitivity and specificity to detect high-grade cervical intraepithelial neoplasia (CIN), via high-risk human papillomavirus (hrHPV) detection and liquid-based cytology (LBC), compared to endocervical brush samples obtained by gynecologists. Women who had a cervical smear reading of moderate dyskaryosis or worse or a repeat equivocal Pap smear result in the cervical screening program (n=64) and healthy volunteers (n=32) took a self-obtained sample at home prior to their visit to the gynecological outpatient department. At the outpatient department, an endocervical brush smear was taken, followed by colposcopy and biopsy whenever applicable. Both self-obtained samples and endocervical brush samples were immediately collected in Surepath preservation solution and used for LBC and hrHPV testing (by general primer-mediated GP5+/6+PCR). hrHPV test results showed a good concordance between the two sample types (87%; kappa=0.71), with sensitivities for prevalent high-grade CIN that did not differ significantly (92% and 95%; P=1.0). The hrHPV test on self-obtained samples proved to be at least as sensitive for high-grade CIN as cytology on endocervical brush samples (34/37 versus 31/37; P=0.5). LBC showed a poor concordance between self-obtained and endocervical brush samples (60%; kappa=0.27). In conclusion, self-obtained samples taken by this novel device are highly representative of the hrHPV status of the cervix. In combination with hrHPV testing, the use of this device may have implications for increasing the attendance rate for cervical screening programs.
authors.affiliation: Department of Pathology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, and Maxima Medical Center, Veldhoven, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Antoinette A T P
authors.initials: AA
authors.lastname: Brink
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.forename: Maarten A H M
authors.initials: MA
authors.lastname: Wiegerinck
authors.forename: Thedoor E
authors.initials: TE
authors.lastname: Nieboer
authors.forename: Roy F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.forename: Folkert
authors.initials: F
authors.lastname: van Kemenade
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fransen Daalmeijer
authors.forename: Albertus T
authors.initials: AT
authors.lastname: Hesselink
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000821:virology; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods