Molecular diagnosis of genital human papillomavirus infection: Comparison of two methods used to collect exfoliated cervical cells

Vermund, Sten H.; Schiffman, M.; Goldberg, GL; Ritter, D; Welman, A; Burk, RD

doi:10.1016/0020-7292(89)90372-x

Cited by 13 publications

(11 citation statements)

References 11 publications

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“…In early work, collection of exfoliated cells involved cervicovaginal lavage (140)(141)(142)(143)(144)(145). Thus, testing for HPV in such exfoliated cells is an alternative way of screening, as shown in a number of studies, with good results.…”

Section: Self-samplingmentioning

confidence: 99%

Cervical screening in the 21st century: the case for human papillomavirus testing of self-collected specimens

Morris

Rose

2007

Clinical Chemical Laboratory Medicine

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Cervical screening by Pap smear involves a high rate of false negatives, necessitating frequent testing. Because women do not like the sampling procedure, many avoid being screened. Testing for the causative high-risk human papillomavirus (HPV) types, by PCR or other technologies, on self-collected (tampon) samples permits women to be monitored non-invasively. The high negative predictive value of HPV testing means a greater interval between tests, and thus reduces costs. HPV testing lends itself to primary screening. A kit for self-collection and return to a testing laboratory, followed by practitioner notification and follow-up if required, should result in wider participation. The higher accuracy of HPV testing should lead to improved cervical cancer prevention.

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Section: Self-samplingmentioning

confidence: 99%

Cervical screening in the 21st century: the case for human papillomavirus testing of self-collected specimens

Morris

Rose

2007

Clinical Chemical Laboratory Medicine

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“…It also lends itself to self-testing options. Studies using cervico-vaginal lavage, vaginal swabs or brushes, and tampons (13-29) suggest that there is good agreement between high-risk HPV DNA detection from self-collected vaginal samples vs. clinician-collected cervical samples and high acceptability of vaginal self-collection (20, 26-28). On the other hand, high-risk HPV testing of self-collected vaginal samples, like HPV testing of clinician-collected cervical samples, is less specific than cytology (23, 30), which leads to increased unnecessary diagnostic and treatment costs associated with false-positive test results.…”

Section: Introductionmentioning

confidence: 99%

Accuracy and Cost-Effectiveness of Cervical Cancer Screening by High-Risk Human Papillomavirus DNA Testing of Self-Collected Vaginal Samples

Balasubramanian

Kulasingam

Baer

et al. 2010

Journal of Lower Genital Tract Disease

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Objective Estimate the accuracy and cost-effectiveness of cervical cancer screening strategies based on high-risk HPV DNA testing of self-collected vaginal samples. Materials and Methods A subset of 1,665 women (18-50 years of age) participating in a cervical cancer screening study were screened by liquid-based cytology and by high-risk HPV DNA testing of both self-collected vaginal swab samples and clinician-collected cervical samples. Women with positive/abnormal screening test results and a subset of women with negative screening test results were triaged to colposcopy. Based on individual and combined test results, five screening strategies were defined. Estimates of sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or worse were calculated and a Markov model was used to estimate the incremental cost-effectiveness ratios (ICERs) for each strategy. Results Compared to cytology-based screening, high-risk HPV DNA testing of self-collected vaginal samples was more sensitive (68%, 95%CI=58%-78% versus 85%, 95%CI=76%-94%) but less specific (89%, 95%CI=86%-91% versus 73%, 95%CI=67%-79%). A strategy of high-risk HPV DNA testing of self-collected vaginal samples followed by cytology triage of HPV positive women, was comparably sensitive (75%, 95%CI=64%-86%) and specific (88%, 95%CI=85%-92%) to cytology-based screening. In-home self-collection for high-risk HPV DNA detection followed by in-clinic cytology triage had a slightly lower lifetime cost and a slightly higher quality-adjusted life expectancy than did cytology-based screening (ICER of triennial screening compared to no screening was $9,871/QALY and $12,878/QALY, respectively). Conclusions Triennial screening by high-risk HPV DNA testing of in-home, self-collected vaginal samples followed by in-clinic cytology triage was cost-effective.

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“…Table I. 1986; Vermund et al, 19891, although we are unaware of any hard evidence for this. Most notably, however, Vermund et al [1989] found that if HPV is detected in a scrape-swab, it is also always detected in the patient's lavage cells; in fact, lavage appeared capable of detecting HPV that was missed by scrape-swab. In addition, a high concordance has been noted for type of HPV detected in lavages and scrape-swabs [Vermund et al, 19891, as well as biopsies [Burk et al, 19861. It was interesting to note that in our study the order in which the lavage specimens for HPV DNA analysis and the scrapes for cytology were collected did not affect the results.…”

Section: Discussionmentioning

confidence: 94%

“…One notable difference in each study is that Melchers et al [1989al used scrapes to obtained cells, whereas we used cervicovaginal lavage. Lavage was adopted because it reportedly gives more cells and a higher detection rate of HPV than scrape-swab [Burk et al, 1986;Vermund et al, 1989;Goldberg et al, 19891. It is claimed, moreover, that lavage samples cells from the crucial transformation zone [Burk et al, an = number of patients.…”

Section: Discussionmentioning

confidence: 99%

Automated polymerase chain reaction for papillomavirus screening of cervicovaginal lavages: Comparison with dot‐blot hybridization in a sexually transmitted diseases clinic population

Morris

Rose

Flanagan

et al. 1990

Journal of Medical Virology

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The aim of the present study was to compare the recently developed polymerase chain reaction (PCR) technique with conventional dot-blot DNA hybridization for human papillomavirus (HPV) detection. Cells were collected by cervicovaginal lavage from a study group of 109 women attending a sexually transmitted diseases clinic. Using a machine that we developed for alternation of temperature cycles, HPV was detected in 51% of patients by PCR. By dot-blot hybridization, 44% of the patients were positive. Concordance of combined positive and negative results between PCR and dot blot was 69%. The greater sensitivity of PCR may have accounted for 19% of specimens that were PCR positive but dot-blot negative. Unexpectedly, however, 12% of specimens were dot-blot positive but negative by PCR, and several specimens were discordant for type of HPV. Both HPV DNA tests agreed with cytology in 41% of women, and in 33% cytology was negative in the face of positive PCR and dot blot. Concordance of cytology with just PCR was 59%, and only with dot blot was 56%. Cervicography agreed with both HPV DNA tests in 41% of patients, with PCR alone in 55%, and with dot blot alone in 58%. Biopsy results did not reveal a strong correlation between histopathological criteria of HPV infection and detection of HPV DNA by either PCR or dot-blot hybridization. Thus the present study has shown that PCR is a slightly more sensitive indicator of HPV infection than dot-blot hybridization. Agreement of HPV DNA results with conventional screening tests was not strong, an observation consistent with many comparative studies by others. In conclusion, PCR is slightly more sensitive than DNA hybridization for detection of HPV, it can be used in conjunction with specimen collection by gentle lavage of the cervicovaginal epithelium, and the possibility remains that it may prove suitable as a screening test.

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Molecular diagnosis of genital human papillomavirus infection: Comparison of two methods used to collect exfoliated cervical cells

Cited by 13 publications

References 11 publications

Cervical screening in the 21st century: the case for human papillomavirus testing of self-collected specimens

Cervical screening in the 21st century: the case for human papillomavirus testing of self-collected specimens

Accuracy and Cost-Effectiveness of Cervical Cancer Screening by High-Risk Human Papillomavirus DNA Testing of Self-Collected Vaginal Samples

Automated polymerase chain reaction for papillomavirus screening of cervicovaginal lavages: Comparison with dot‐blot hybridization in a sexually transmitted diseases clinic population

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