title: Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare the detection rate of genital human papillomavirus (HPV) infection in self- and physician-obtained samples.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Studies published between 1966 and November 2005 identified through Medline and Embase that compared both sampling methods.
  
  
  METHODS
  We calculated the concordance and kappa statistic between physician- and self-sampling and the difference between proportions of HPV positive samples. Weighted averages were reported with 95% confidence intervals (CI) using a random-effects model.
  
  
  RESULTS
  Eighteen studies (5441 participants) were included that evaluated broad HPV type categories, 10 (3688 patients) that of high-risk (HR) HPV and three (530) that of low-risk (LR) HPV. A high level of concordance of 0.87 (95%CI, 0.82 to 0.91) between self- and physician-sampling was obtained for detection of HPV DNA (kappa 0.66, 95%CI, 0.56 to 0.76). The prevalence difference of HPV DNA between sampling methods was -0.5 (95%CI, -2.8 to 1.8). Results were similar when restricting the analysis to HR-HPV but the prevalence of LR-HPV types was higher in self-collected samples.
  
  
  CONCLUSIONS
  Self-sampling was as sensitive as physician-obtained sampling to detect HR-HPV or HPV DNA. Self-sampling may be a suitable alternative method for studies on HPV transmission and vaccine trials.
authors.affiliation: Senology and Gynaecologic Oncology Unit, Geneva University Hospitals, 1211 Geneva 14, Switzerland. patrick.petignat@hcuge.ch
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Faltin
authors.forename: Ilan
authors.initials: I
authors.lastname: Bruchim
authors.forename: Martin R
authors.initials: MR
authors.lastname: Tramèr
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: François
authors.initials: F
authors.lastname: Coutlée
mesh_terms: D002584:Cervix Uteri / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D010819:Physician's Role; D016353:Self-Examination; D013048:Specimen Handling / Q000379:methods*; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral