title: Urine-based human papillomavirus DNA testing as a screening tool for cervical cancer in high-risk women.
abstract: OBJECTIVE
  To test the hypothesis that self-collected urine could be used to detect high-risk human papillomavirus (HPV) DNA with sensitivity and specificity comparable to those of standard cervical testing.
  
  
  METHODS
  Women attending a gynecology clinic for evaluation of abnormal cytology were recruited. Fifty-two participants (21-60years of age) collected urine samples, and clinicians collected cervical brush samples. When appropriate, cervical biopsies were obtained during colposcopy. HPV detection and typing were performed on DNA extracts from each sample, using commercial reagents for L1 consensus polymerase chain reaction (PCR) and type-specific hybridization. HPV 16 viral load was determined by quantitative PCR in HPV 16-positive samples. A diagnostic test analysis was conducted for urine samples.
  
  
  RESULTS
  Fifty paired samples were analyzed, with 76% agreement between samples. The 12 discrepant pairs were all urine negative/cervix positive. The most common HPV types detected were 16, 51, 53, and 62. The urine test correctly identified 100% of the uninfected and 65% of the infected patients.
  
  
  CONCLUSIONS
  The results indicate that HPV DNA detection using urine is less sensitive than cervical sampling in a population with abnormal cytology. Further exploration is warranted to determine clinical utility when other options are unavailable.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Puerto Rico, San Juan, USA. Electronic address: keimari.mendez@upr.edu.
authors.forename: Keimari
authors.initials: K
authors.lastname: Mendez
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Puerto Rico, San Juan, USA.
authors.forename: Josefina
authors.initials: J
authors.lastname: Romaguera
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Public Health, Cancer Control and Population Sciences Program at Comprehensive Cancer Center, University of Puerto Rico, San Juan, USA.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Ortiz
authors.affiliation: Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico, San Juan, USA.
authors.forename: Mariel
authors.initials: M
authors.lastname: López
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinau
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification*; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D015344:DNA Probes, HPV; D004279:DNA, Viral / Q000652:urine*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D055815:Young Adult
chemical_list: D015344:DNA Probes, HPV; D004279:DNA, Viral
keywords: Cancer screening; Cervical cancer; Human papillomavirus; Urine samples