title: Vaginal self-sampling without preservative for human papillomavirus testing shows good sensitivity.
abstract: BACKGROUND
  Several strategies have been used to reach non-attending women in organized cervical-cancer-screening programs, with varying success. Self-sampling (SS) for HPV is effective for increasing coverage in screening programs, but requires expensive commercial sampling kits.
  
  
  OBJECTIVE
  We aimed to evaluate if vaginal SS, without commercial preservatives was adequate for HPV testing.
  
  
  METHODS
  Women with abnormal cervical smears as determined from the organized screening program were invited to a colposcopy clinic. The 121 women were asked to insert a cotton swab into the vagina and rotate it, put the cotton swab into a sterile cryotube, break the upper part of the stick and put the cap on. Thereafter, the gynaecologist collected a liquid based cytology (LBC) sample. The presence of HPV-types in SS and LBC samples was analysed with PCR and luminex-based typing.
  
  
  RESULTS
  High-risk-HPV (hr-HPV) DNA was found in 65 of the tested 108 SS (60%; 95% CI 0.50-0.69), whereas LBC found hr-HPV in 64/108 samples (59%; 95% CI 0.49-0.69). The agreement between sampling with SS and LBC was good, kappa value 0.67 (95% CI; 0.53-0.81). The sensitivity for SS with hr-HPV to find HSIL was 77% (95% CI; 62-91%), specificity 47% (95% CI; 35-59%) [corrected] and the sensitivity for LBC with hr-HPV to find HSIL was 79% (95% CI 66-93%), specificity 50% (95% CI; 38-62%). [corrected]
  
  
  CONCLUSIONS
  This new vaginal self-sampling method detects hr-HPV-infections with similar sensitivity as a cervical smear taken by a gynaecologist. This self-sampling method is cost-effective and well tolerated, and the kit is suitable for regular mail transport.
authors.affiliation: Department of Obstetrics and Gynaecology, Skane University Hospital, Lund University, Sweden. Lotten.Darlin@med.lu.se
authors.forename: Lotten
authors.initials: L
authors.lastname: Darlin
authors.forename: Christer
authors.initials: C
authors.lastname: Borgfeldt
authors.forename: Ola
authors.initials: O
authors.lastname: Forslund
authors.forename: Emir
authors.initials: E
authors.lastname: Hénic
authors.forename: Joakim
authors.initials: J
authors.lastname: Dillner
authors.forename: Päivi
authors.initials: P
authors.lastname: Kannisto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010342:Patient Acceptance of Health Care; D012646:Self Administration / Q000379:methods*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D055815:Young Adult