title: Accuracy of dry vaginal self-sampling for detecting high-risk human papillomavirus infection in cervical cancer screening: a cross-sectional study.
abstract: OBJECTIVE
  Cervical cancer screening coverage remains insufficient in most countries. Testing self-collected samples for high-risk human papillomavirus (HR-HPV) could be an alternative to the Pap smear, but costs, sampling methods and transport issues hamper its wide use. Our objective was to compare diagnostic accuracy of 2 vaginal self-collection methods, a dry swab (vsc-DRY) or swab in liquid medium (vsc-LIQ), for detecting HR-HPV cervical infection assessed by a cervical clinician-collected sample in liquid medium (ccc-LIQ).
  
  
  METHODS
  Women 20 to 65 years attending a Pap smear were recruited between September, 2009 and March, 2011. Each sample (3 per woman) underwent HPV DNA testing. Samples were classified as HR-HPV+ with detection of at least one HR-HPV or probable HR-HPV type.
  
  
  RESULTS
  Of 734 women included, 722 had complete HPV data. HR-HPV was detected in 20.9% of ccc-LIQ samples. Estimated sensitivity and specificity to detect HR-HPV in vsc-DRY samples were 88.7% and 92.5%, respectively, and in vsc-LIQ samples, 87.4% and 90.9%. Cytology findings were abnormal for 79 women (10.9%): among 27 samples of low-grade squamous intraepithelial lesions, 25 were HR-HPV+ in vsc-DRY, vsc-LIQ and ccc-LIQ samples. Among 6 samples of high-grade squamous intraepithelial lesions, all were HR-HPV+ in vsc-DRY samples, 1 was HR-HPV- in vsc-LIQ samples and 1 was HR-HPV- in ccc-LIQ samples.
  
  
  CONCLUSIONS
  Vaginal self-sampling with a dry swab is accurate to detect HR-HPV infection as compared with cervical clinician-collection and accurate as compared with cytology results. This cheap and easy-to-ship sampling method could be widely used in a cervical cancer screening program.
authors.affiliation: INSERM, U1153 Paris, France; CHRU de Tours, Department of Cancer Screening, Tours, France. Electronic address: ken.haguenoer@univ-tours.fr.
authors.forename: K
authors.initials: K
authors.lastname: Haguenoer
authors.affiliation: INSERM, U1153 Paris, France; CHRU de Tours, INSERM CIC 0202, Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
authors.forename: B
authors.initials: B
authors.lastname: Giraudeau
authors.affiliation: Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; INSERM U966, Tours, France; CHRU de Tours, Department of Bacteriology and Virology, Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Gaudy-Graffin
authors.affiliation: Institut inter-Régional pour la Santé (IRSA), Tours, France.
authors.forename: I
authors.initials: I
authors.lastname: de Pinieux
authors.affiliation: CHRU de Tours, Department of Bacteriology and Virology, Tours, France; Institut inter-Régional pour la Santé (IRSA), Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Dubois
authors.affiliation: CHRU de Tours, Birth Control Care Center, Tours, France.
authors.forename: N
authors.initials: N
authors.lastname: Trignol-Viguier
authors.affiliation: CHRU de Tours, Department of Cancer Screening, Tours, France.
authors.forename: J
authors.initials: J
authors.lastname: Viguier
authors.affiliation: Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; CHRU de Tours, Department of Gynecology and Obstetrics, Tours, France.
authors.forename: H
authors.initials: H
authors.lastname: Marret
authors.affiliation: Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; INSERM U966, Tours, France; CHRU de Tours, Department of Bacteriology and Virology, Tours, France.
authors.forename: A
authors.initials: A
authors.lastname: Goudeau
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology*; D015203:Reproducibility of Results; D013048:Specimen Handling / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014621:Vagina / Q000821:virology*; D055815:Young Adult
keywords: Cervical cancer; Dry swab; Human papillomavirus; Mass screening; Self sampling