title: Concordance between hybrid capture 2 results performed on cervical samples obtained before and immediately after visual inspection with acetic Acid test.
abstract: BACKGROUND
  VIA is a simple, inexpensive test widely advocated for resource-limited settings. Major limitation of VIA is its low specificity. HPV DNA testing can be used to triage VIA-positive women if the facilities are available. The major concern for such strategy would be whether sample collection after acetic acid wash will alter HPV test characteristics. This study aimed to evaluate whether samples for HPV testing by Hybrid Capture 2 (HC2) technology can be collected immediately after VIA without altering test performance.
  
  
  METHODS
  Total 204 VIA-positive women were recruited. Cervical samples were collected for HC2 test before and after VIA at the same sitting by the same provider. The paired samples were analyzed at the same laboratory by the same technician in the same batch of testing. Agreement in HC2 results between pre-VIA and post-VIA samples was estimated using kappa statistics. All women had colposcopy and biopsies were obtained if colposcopy was suspicious of neoplasia. Sensitivity and specificity of HC2 test in detecting CIN2+ lesions were calculated using negative colposcopy or biopsy as the gold standard and were compared between the pre and post VIA samples.
  
  
  RESULTS
  Almost perfect agreement in HC2 results (kappa=0.85) and RLU/Cut off ratios (correlation coefficient=0.92) was observed between samples collected before and after VIA. The sensitivity and specificity to detect CIN2+ lesions remained unaltered even when cervical samples were collected after VIA. This confirmed that acetic acid wash did not alter HC2 performance.
  
  
  CONCLUSIONS
  Collection of samples for HC2 test is feasible immediately after VIA.
authors.affiliation: Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Partha
authors.initials: P
authors.lastname: Basu
authors.affiliation: Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Anushree
authors.initials: A
authors.lastname: Samaddar
authors.affiliation: Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Srabani
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Urmimala
authors.initials: U
authors.lastname: Basu
authors.affiliation: Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Simi
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Department of Surgical Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
keywords: Cervical cancer screening; hybrid capture 2; triaging; viral load; visual inspection with acetic acid