Concordance between urine and self-collected vaginal samples for high-risk HPV detection in cervical cancer screening
DOI:
https://doi.org/10.18203/2349-3259.ijct20231108Keywords:
Human papilloma virus, Cervical cancer, Urine sampling, Cobas 4800, High risk HPV detection, CIN 2 detection, Vaginal samplingAbstract
Background: A system comprising of screening for pre-cancerous lesions succeeded by therapeutic interventions can greatly reduce the incidence of cervical cancer. High risk HPV detection in urine has proven itself as a potential primary screening tool. However, only a few studies have showed it’s concordance with matched self-collected vaginal samples while screening for high risk HPV infection in the community. Objective of the study was to determine the concordance between first void urine sample and self-collected vaginal sample for high risk HPV detection using Cobas 4800. The sensitivity and positive predictive value of screening by urine HPV testing for CIN 2+ detection would also be done along with its acceptability and cost analysis in community screening.
Methods: This study will include women between 30-60 years with intact cervix and no precancerous lesions. Self-sampling will be provided by participants in the form of urine and vaginal swab collection by the Collipee device and vaginal swab stick respectively. This will be followed by high risk HPV testing using Cobas 4800 technology. The participants will also be asked to fill up a questionnaire about the acceptability of urine sampling for cancer screening.
Conclusions: Screening tools can perhaps be diversified in order to suit the needs of low and middle income countries. Research and development of cervical cancer screening tools could hence bring to light feasible alternatives that could further improve compliance of non-attenders.
Trial registration: The trial is registered with clinical trials registry (CTRI/2023/01/049322).
References
World Health Organization. India Fact Sheet. 2020. Available at: https://gco.iarc.fr/today/data/fact sheets/populations/356-india-fact-sheets.pdf. Accessed on 09 December 2022.
World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. Geneva. 2021. Available at: https://www.who.int/publications/i/item/9789240040434. Accessed on 09 December 2022.
Mehrotra R, Yadav K. Cervical Cancer: Formulation and Implementation of Govt of India Guidelines for Screening and Management. Indian J Gynecol Oncol. 2022;20:4.
Bhatla N, Singhal S, Saraiya U, Srivastava S, Bhalerao S, Shamsunder S, et al. Screening and management of preinvasive lesions of the cervix: Good clinical practice recommendations from the Federation of Obstetrics and Gynaecologic Societies of India (FOGSI). J Obstet Gynaecol Res. 2020;46(2):201-14.
Pattyn J, Van Keer S, Biesmans S, Ieven M, Vanderborght C, Beyers K, et al. Human papillomavirus detection in urine: Effect of a first-void urine collection device and timing of collection. J Virol Methods. 2019;264:23-30.
Laeremans M, Mehta A, Pasmans D, Jordaens S, Faster D, Beyers K, et al. HPV-based cervical cancer screening: Gaining insights in sample preferenceand cost-effectiveness. Novosanis white paper, unpublished. 2021.
Bober P, Firment P, Sabo J. Diagnostic Test Accuracy of First-Void Urine Human Papillomaviruses for Presence Cervical HPV in Women: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(24):13314.
Pathak N, Dodds J, Zamora J. Could urine testing be the future of cervical cancer screening? Womens Health (Lond). 2015;11(3):265-7.
Franceschi S, Chantal Umulisa M, Tshomo U, Gheit T, Baussano I, Tenet V, et al. Urine testing to monitor the impact of HPV vaccination in Bhutan and Rwanda. Int J Cancer. 2016;139(3):518-26.
Tshomo U, Franceschi S, Tshokey T, Tobgay T, Baussano I, Tenet V, et al. Evaluation of the performance of Human Papillomavirus testing in paired urine and clinician-collected cervical samples among women aged over 30 years in Bhutan. Virol J. 2017;14(1):74.
Nilyanimit P, Chansaenroj J, Karalak A, Laowahutanont P, Junyangdikul P, Poovorawan Y. Comparison of human papillomavirus (HPV) detection in urine and cervical swab samples using the HPV GenoArray Diagnostic assay. PeerJ. 2017;5:e3910.
Asciutto KC, Henic E, Forslund O, Darlin L, Borgfeldt C. Follow up with HPV test and cytology as test of cure, 6 months after conizationreliable. Acta obstetricia et gynecologica Scandinavica. 2016;95(11):1251-7.
Cuschieri K, Bhatia R, Cruickshank M, Hillemanns P, Arbyn M. HPV testing in the context of post-treatment follow up (test of cure). J Clin Virol. 2016;76:S56-61.
Flanagan MB. Primary high-risk human papillomavirus testing for cervical cancer screening in the United States: Is it time? Arch Pathol Lab Med. 2018;142:688-92.
Daponte A, Pournaras S, Mademtzis I, Hadjichristodoulou C, Kostopoulou E, Maniatis AN, et al. Evaluation of HPV 16 PCR detection in self- compared with clinician-collected samples in women referred for colposcopy. Gynecol Oncol. 2006;103:463-6.
Daponte A, Tsezou A, Oikonomou P, Hadjichristodoulou C, Maniatis AN, Pournaras S, et al. Use of real-time PCR to detect human papillomavirus-16 viral loads in vaginal and urine self-sampled specimens. Clin Microbiol Ainfection. 2008;14:619-21.
Daponte A, Pournaras S, Mademtzis I, Hadjichristodoulou C, Kostopoulou E, Maniatis AN, et al. Evaluation of high-risk human papillomavirus types PCR detection in paired urine and cervical samples ofwomen with abnormal cytology. J Clin Virol. 2006;36:189-93.
Mantzana P, Pournaras S, Skentou C, Deligeoroglou E, Katsioulis A, Antonakopoulos G, et al. Applicability of self-obtained urine and vaginal samples for HPV-16, -18, -31 and -45 cervical cancer screening in pregnancy: A pilot cross-sectional study. Future Virol. 2014;9:385-95.
Pathak N, Dodds J, Zamora J, Khan K. Accuracy of urinary human papillomavirus testing for presence of cervical HPV: Systematic review and meta-analysis. BMJ. 2014;349:5264.
Cadman L, Reuter C, Jitlal M, Kleeman M, Austin J, Hollingworth T, et al. A Randomized Comparison of Different Vaginal Self-sampling Devices and Urine for Human Papillomavirus Testing-Predictors 5.1. Cancer Epidemiol Biomarkers Prev. 2021;30(4):661-8.
Martinelli M, Musumeci R, Crotti C. New strategies in cervical cancer screening: evaluation of accuracy of HPV-testing on vaginal and first-void urine self-samples versus clinician-collected cervical samples. PHE. 2019.
Arbyn M, Peeters E, Benoy I, Vanden Broeck D, Bogers J, De Sutter P, et al. VALHUDES: A protocol for validation of human papillomavirus assays and collection devices for HPV testing on self-samples and urine samples. J Clin Virol. 2018;107:52-6.
Maged AM, Saad H, Salah E, Meshaal H, AbdElbar M, Omran E, Eldaly A. Urine test for HPV genotypes as a predictor of precancerous cervical lesions and for cervical cancer screening. Int J Gynaecol Obstet. 2018;141(3):332-6.
Sargent A, Fletcher S, Bray K, Kitchener HC, Crosbie EJ. Cross-sectional study of HPV testing in self-sampled urine and comparison with matched vaginal and cervical samples in women attending colposcopy for the management of abnormal cervical screening. BMJ Open. 2019;9(4):e025388.
Ornskov D, Jochumsen K, Steiner PH, Grunnet IM, Lykkebo AW, Waldstrom M. Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study. BMJ Open. 2021;11:e041512.
Poli UR, Muwonge R, Bhoopal T, Lucas E, Basu P. Feasibility, Acceptability, and Efficacy of a Community Health Worker–Driven Approach to Screen Hard-to-Reach Periurban Women Using Self-Sampled HPV Detection Test in India. JCO Global Oncol. 2020;6:658-66.
Sabeena S, Kuriakose S, Binesh D, Abdulmajeed J, Dsouza G, Ramachandran A, et al. The Utility of Urine-Based Sampling for Cervical Cancer Screening in Low-Resource Settings. Asian Pac J Cancer Prev. 2019;20(8):2409-13.
Vorsters A. Evaluation of the Roche cobas® HPV assay with Colli-Pee® collected, UCMpreserved Urine. Research poster presented at Eurogin. 2016.
Vorsters A. Evaluation of the Roche COBAS ® 6800 HPV assay with Colli-Pee® collected, UCM preserved Urine. Research poster presented at Eurogin. 2017.
Altman DG. Practical statistics for medical research: Chapman and Hall/CRC. 1991.