Validity and Reliability of Using a Self-Lavaging Device for Cytology and HPV Testing for Cervical Cancer Screening: Findings from a Pilot Study

Abstract

Self-sampling could increase cervical cancer screening uptake. While methods have been identified for human papillomavirus (HPV) testing, to date, self-sampling has not provided adequate specimens for cytology. We piloted the validity and reliability of using a self-lavaging device for cervical cytology and HPV testing. We enrolled 198 women in New York City in 2008–2009 from three ambulatory clinics where they received cervical cancer screening. All were asked to use the Delphi Screener™ to self-lavage 1–3 months after clinician-collected index cytological smear (100 normal; 98 abnormal). Women with abnormal cytology results from either specimen underwent colposcopy; 10 women with normal results from both specimens also underwent colposcopy. We calculated sensitivity of self-collected cytology to detect histologically confirmed high grade lesions (cervical intraepithelial neoplasia, CIN, 2+); specificity for histology-negative (CIN 1 or lower), paired cytology negative, or a third cytology negative; and kappa for paired results. One hundred and ninety-seven (99.5%) women self-collected a lavage. Seventy-five percent had moderate to excellent cellularity, two specimens were unsatisfactory for cytology. Seven of 167 (4%) women with definitive results had CIN2+; one had normal and six abnormal cytology results with the self-lavage (sensitivity = 86%, 95% Confidence Interval, CI: 42, 100). The kappa for paired cytology was low (0.36; 95% CI: 0.25, 0.47) primarily due to clinician specimens with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) coded as normal using Screener specimens. However, three cases of HSIL were coded as ASC-US and one as normal using Screener specimens. Seventy-three women had paired high-risk HPV tests with a kappa of 0.66 (95% CI: 0.49, 0.84). Based on these preliminary findings, a larger study to estimate the performance of the Screener for co-testing cytology and HPV or for HPV testing with cytology triage is warranted.Trial RegistrationClinicalTrials.gov NCT00702208

Polymicrobial Amniotic Fluid Infection withMycoplasma/Ureaplasmaand Other Bacteria Induces Severe Intra-Amniotic Inflammation Associated with Poor Perinatal Prognosis in Preterm Labor

“…[4][5][6][7] Mycoplasma and Ureaplasma spp are among the organisms most frequently isolated from both placenta and amniotic fluid (AF) in spontaneous preterm delivery. [8][9][10] The standard microbial culture method for detecting microorganisms, such as Mycoplasma, Ureaplasma, and other aerobic or anaerobic bacteria, requires 1 week to obtain the results.…”

Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer

“…When reported, relative sensitivities for CIN2 + were low and ranged between 33% and 75%. 159 , 160 Several studies have shown comparable or improved specificity of self-collected cytology compared to clinician-collected samples. 155 , 157 , 159 …”

“…When reported, relative sensitivities for CIN2 + were low and ranged between 33% and 75%. 159,160 Several studies have shown comparable or improved specificity of self-collected cytology compared to clinician-collected samples. 155,157,159 In a recent prospective cohort study, Loopik et al showed reflex cytology is feasible on hrHPV-positive self-samples and could be considered as an additional triage test for immediate referral to decrease loss to follow-up in screening.…”

“…159,160 Several studies have shown comparable or improved specificity of self-collected cytology compared to clinician-collected samples. 155,157,159 In a recent prospective cohort study, Loopik et al showed reflex cytology is feasible on hrHPV-positive self-samples and could be considered as an additional triage test for immediate referral to decrease loss to follow-up in screening. 161 The authors also noted a lack of endocervical, endometrial, and inflammatory cells, which made interpretation of the slides easier, but not necessarily as reliable.…”

Violaceína desliga a sinalização dependente dos receptores tirosina quinases (AXL e EGFR) em células de câncer colorretal (HT29)

“…No campo de pesquisa da biologia dos tumores, a cultura de células tem sido o pilar para o avanço dessa área. Em parte, isso se deve à identificação de que muitas linhagens apresentam aberrações genéticas e epigenéticas que também são encontradas em biópsias do tecido tumoral correspondente (SAAF et al, 2007;VAN STAVEREN et al, 2009;MACLEOD et al, 1999;JONES et al, 2013;GAYET et al, 2001). Nesse contexto, no estudo realizado por Mouradov e colaboradores (2014)…”