Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis.
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.
Petignat
Patrick
P
Senology and Gynaecologic Oncology Unit, Geneva University Hospitals, 1211 Geneva 14, Switzerland. patrick.petignat@hcuge.ch
Faltin
Daniel L
DL
Bruchim
Ilan
I
Tramèr
Martin R
MR
Franco
Eduardo L
EL
Coutlée
François
F
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
D004279:DNA, Viral