The Role of Self-Collection by Vaginal Lavage for the Detection of HPV and High-Grade Intraepithelial Neoplasia

Abstract

Objective: To compare the results of cervical cytology and high-risk HPV tests using samples obtained using two different collection modalities in a population of Brazilian women: self-collection (vaginal lavage) and cervical Pap testing. Methods: We enrolled 204 women who were aged 18-64 years and had previously obtained abnormal cervical cytology test results; 83.8% of them agreed to participate. The sample was divided into two aliquots: one for the cytological study and one for the molecular analysis of high-risk HPV. Results: Fifty-eight percent of the participants preferred to utilize self-collection as an alternative screening method. However, we noticed that the HPV positivity rate was significantly lower in self-collected samples when compared to those obtained using the conventional collection method (p = 0.035). The cytology tests of the samples obtained via self-collection were sensitive and had a positive predictive value and an area under the curve (AUC) that were significantly lower than those of the Pap test. However, the specificity and negative predictive value of these tests were similar. When compared with the HPV test, the self-collected samples demonstrated lower accuracy in predicting high-grade cervical intraepithelial neoplasia or worse, with a significantly lower sensitivity, positive predictive value, and AUC than the cervical Pap test samples. Conclusion: Self-collection by vaginal lavage is simple and well accepted by women. Due to its limitations, however, self-collection by lavage should be utilized with caution.

Test performance and acceptability of self- versus provider-collected swabs for high-risk HPV DNA testing in female-to-male trans masculine patients

“…Sampling accuracy could potentially be increased by refining self-swabbing instructions. Additionally, several self-collection devices and methods have been used and are currently under evaluation, such as cytobrush,[ 31 , 32 , 58 ] tampon,[ 59 , 60 ] cervical lavage,[ 61 , 62 ] and dry storage and transport devices;[ 63 , 64 ] it is possible that they may be less prone to user error, perform better than the self-swab, and warrant future evaluation in TM patients.…”

Self‑sampling for high‑risk human papillomavirus as a follow‑up alternative after treatment of high‑grade cervical intraepithelial neoplasia

“…The home self-sampling option could be particularly favorable as an alternative to clinic visits in face of the current COVID19-pandemic, plus being convenient and cost-effective (9). Self-collection of samples for HPV testing is becoming an increasingly accepted, and even preferred cervical screening option for many women (34)(35)(36)(37)(38)(39)(40)(41)(42).…”

A Comprehensive Review of Cervical Cancer Screening Devices: The Pros and the Cons

“…The limitation of this method is the leakage of fluid out of vagina, which results in partial loss in sample and discomfort of women. Besides, a study in Brazil found that self-collected lavage sensitivity for CIN 2+ cytology and HPV DNA results are only 33.3 % and 50 %, which is much lower than cytology samples obtained by clinicians (Kuil et al, 2017). A similar results for CIN 2+ sensitivity was reported at 42 %, but with higher sensitivity for HPV DNA tests at 81 % (Nobbenhuis et al, 2002) To solve the issues mentioned, Rovers® Medical Devices came up with a vaginal lavage device known as Delphi screener as shown in Figure 2.…”