title: HPV detection in a self-collected vaginal swab combined with VIA for cervical cancer screening with correlation to histologically confirmed CIN.
abstract: OBJECTIVE
  To first compare the accuracy of self-, Physician-HPV testing and VIA as standalone screening tests; and second to compare the accuracy of Self-HPV positive test triaged with VIA with the different standalone screening tests as colposcopy and histologically confirmed CIN for cervical cancer screening in low-resource settings
  
  
  METHODS
  1,601 women in Sharkya Governerate, Egypt concurrently received HPV DNA testing [Hybrid Capture 2 (HC2) assay] for self-collected and physician-obtained samples, and VIA. Women who tested positive for HPV DNA or VIA received colposcopy and biopsy.
  
  
  RESULTS
  Percentage of women testing positive was 84.8 % on Self-HPV, 87.8 % on Physician-HPV, and 76.8 % on VIA. Test positivity increased in all screening methods with increasing severity of histopathologic diagnosis. Physician-HPV and HPV testing on a self-sample showed a very good agreement for HPV testing results [κ = 0.89 (95 % CI = 0.52-0.79)]; no statistically significant variation between age groups in the sensitivities of HPV testing on a self-sample, Physician-HPV testing for detecting CIN2 or CIN3 lesions. Conversely, VIA sensitivity was lower in detecting CIN2 and CIN3 than HPV testing on a self-sample and decreased significantly in the older age groups. HPV testing on a self-sample positive combined with VIA increases specificity to 98.1 % for CIN2 and 99.4 % for CIN3, and decreased colposcopy referral rate to 2.5 %.
  
  
  CONCLUSIONS
  HPV testing on a self-sample is more accurate than VIA and as accurate as clinician-HPV testing for cervical cancer in low-resource settings.
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, 00202, Egypt.
authors.forename: Ebtesam M
authors.initials: EM
authors.lastname: Kamal
authors.forename: Gamal Abbas
authors.initials: GA
authors.lastname: El Sayed
authors.forename: Manal M
authors.initials: MM
authors.lastname: El Behery
authors.forename: Gehan A
authors.initials: GA
authors.lastname: El Shennawy
mesh_terms: D019342:Acetic Acid; D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D004534:Egypt; D005260:Female; D061809:Human Papillomavirus DNA Tests; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control; D010808:Physical Examination / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D013048:Specimen Handling / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000517:prevention & control
chemical_list: D019342:Acetic Acid