HPV detection in a self-collected vaginal swab combined with VIA for cervical cancer screening with correlation to histologically confirmed CIN.

Aim: 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 %.

Conclusion: 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.