Role of Self-Sampling for Cervical Cancer Screening: Diagnostic Test Properties of Three Tests for the Diagnosis of HPV in Rural Communities of Cuenca, Ecuador

Abstract

Background: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Results: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2–99.9), and specificity 92.1% (IC 85.2–95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2–96.9). The negative predictive value was 98.9% (IC 94.2–99.8) for vaginal self-sampling and 97.6% (IC 92.6–99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory.

Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study

“…New screening tests for HPV are being used, such as the self-sampling and urine tests. Although not yet routinely used, these tests have been validated for use in rural areas in Ecuador [ 31 ]. In our study, most of the participants were unaware of this type of test, and the researchers had to explain the topic.…”

“…Another study on diagnostic tests, conducted on 120 women in rural communities of Cuenca, Ecuador, compared the sensitivity and specificity of clinical sampling versus vaginal and urine self-sampling for HPV diagnosis and found a self-sampling sensitivity of 94.4% (CI 74.2–99.9) and specificity of 92.1 (CI 85.2–95.9), with a negative predictive value of 98.9%; further, urine sampling presented a sensitivity of 88.8% (CI 67.2–96.9) and a specificity of 94.1% (CI 67.2–96.9), with a negative predictive value of 97.6%. In conclusion, self-sampling shows similar sensitivity and specificity when compared to clinical HPV sampling [ 31 ].…”

Cervical cancer screening in high-altitude areas in China: A large cross-section study of 25,173 women in northern Tibet

“…The higher the altitude, the higher the prevalence of HPV in women. We searched for related studies performed in high-altitude areas all over the world and found that HPV prevalence was high (38.2%) in high-altitude areas of Ecuador, a Latin American country with a largely high altitude, although it was a hospital-based rather than a community-based investigation ( 32 ). As mentioned earlier, in China, HPV infection rates at different altitudes in Shanxi were 14.8%, 11.3%, 17%, 13.3%, and 18.1%, respectively.…”

Radiomics Diagnostic Tool Based on Deep Learning for Colposcopy Image Classification

“…The private dataset was composed of images collected from 64 participants of the CAMIE project, who tested positive for HPV or had presented an abnormal pap smear and were referred to colposcopy. During the colposcopy examination after the acetic acid application, the cervix visualizations were classified as normal or abnormal by a reference colposcopist, who had the information of the HPV test and pap smear prior to his colposcopy evaluation, as is standard practice [ 13 ]. This classification is considered to be the golden standard for the present study.…”