Clinical performance of hrHPV primary screening using vaginal versus cervical samples to detect high-grade intraepithelial lesions
Menée au Mexique à partir de l'analyse de données portant sur 5 856 femmes ayant bénéficié d'un dépistage du cancer du col de l'utérus basé sur la recherche de papillomavirus à risque oncogène élevé, cette étude compare, du point de vue du nombre de lésions cervicales intraépithéliales de haut grade détectées, la performance de trois stratégies de dépistage en fonction du type d'échantillons utilisés (échantillons cervicaux prélevés par un praticien ou auto-prélèvement d'échantillons vaginaux)
High-risk human papillomavirus (hrHPV) testing is now the most recommended primary method for cervical cancer screening worldwide. Clinician-collected cervical sampling continues to be the main sampling method, but hrHPV vaginal self-sampling is an appealing alternative because of its greater acceptability and potentially higher cost-effectiveness. This study aimed to determine if hrHPV vaginal self-sampling is comparable to clinician-collected cervical sampling for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2/3) as part of a cervical cancer screening program in Mexico. We analyzed data from 5,856 women screened during a hrHPV-based screening study. Clinical performance and diagnostic efficiency metrics were estimated for the two sampling methods for the CIN3 and CIN2+ endpoints, using three triage strategies: HPV16/18 genotyping, HPV16/18/33/58 extended genotyping, and HPV16/18/31/33/58 extended genotyping. hrHPV-positivity was found in 801 (13.7%) cervical and 897 (15.3%) vaginal samples. All women with hrHPV-positive samples were referred to colposcopy, which detected 17 total CIN3 cases before considering retrospective triage strategies. Using the HPV16/18/31/33/58 extended genotyping strategy, 245 women had hrHPV-positive cervical samples and 269 had hrHPV-positive vaginal samples. Ten CIN3 cases were detected each among women with hrHPV-positive cervical samples and among those with hrHPV-positive vaginal samples when using this strategy, with no significant differences in sensitivity and specificity observed. We observe that self- and clinician-collected sampling methods are comparable for detecting CIN3 and CIN2+ regardless of the triage strategy used. These findings can help public health officials to develop more cost-effective cervical cancer screening programs that maximize participation.
Cancer Prevention Research , article en libre accès, 2022