Haguenoer K, Giraudeau B, Gaudy-Graffin C, de Pinieux I, Dubois F, Trignol-Viguier N, Viguier J, Marret H, Goudeau A
INSERM, U1153 Paris, France; CHRU de Tours, Department of Cancer Screening, Tours, France.
INSERM, U1153 Paris, France; CHRU de Tours, INSERM CIC 0202, Tours, France; Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
Gynecol Oncol. 2014 Aug;134(2):302-8. doi: 10.1016/j.ygyno.2014.05.026. Epub 2014 Jun 3.
Cervical cancer screening coverage remains insufficient in most countries. Testing self-collected samples for high-risk human papillomavirus (HR-HPV) could be an alternative to the Pap smear, but costs, sampling methods and transport issues hamper its wide use. Our objective was to compare diagnostic accuracy of 2 vaginal self-collection methods, a dry swab (vsc-DRY) or swab in liquid medium (vsc-LIQ), for detecting HR-HPV cervical infection assessed by a cervical clinician-collected sample in liquid medium (ccc-LIQ).
Women 20 to 65 years attending a Pap smear were recruited between September, 2009 and March, 2011. Each sample (3 per woman) underwent HPV DNA testing. Samples were classified as HR-HPV+ with detection of at least one HR-HPV or probable HR-HPV type.
Of 734 women included, 722 had complete HPV data. HR-HPV was detected in 20.9% of ccc-LIQ samples. Estimated sensitivity and specificity to detect HR-HPV in vsc-DRY samples were 88.7% and 92.5%, respectively, and in vsc-LIQ samples, 87.4% and 90.9%. Cytology findings were abnormal for 79 women (10.9%): among 27 samples of low-grade squamous intraepithelial lesions, 25 were HR-HPV+ in vsc-DRY, vsc-LIQ and ccc-LIQ samples. Among 6 samples of high-grade squamous intraepithelial lesions, all were HR-HPV+ in vsc-DRY samples, 1 was HR-HPV- in vsc-LIQ samples and 1 was HR-HPV- in ccc-LIQ samples.
Vaginal self-sampling with a dry swab is accurate to detect HR-HPV infection as compared with cervical clinician-collection and accurate as compared with cytology results. This cheap and easy-to-ship sampling method could be widely used in a cervical cancer screening program.
在大多数国家，宫颈癌筛查覆盖率仍然不足。检测自我采集样本中的高危型人乳头瘤病毒（HR-HPV）可能是巴氏涂片检查的一种替代方法，但成本、采样方法和运输问题阻碍了其广泛应用。我们的目的是比较两种阴道自我采集方法（干拭子法（vsc-DRY）或液体培养基中的拭子法（vsc-LIQ））检测HR-HPV宫颈感染的诊断准确性，以宫颈临床医生在液体培养基中采集的样本（ccc-LIQ）作为评估标准。
招募2009年9月至2011年3月期间接受巴氏涂片检查的20至65岁女性。每个样本（每位女性3个）均进行HPV DNA检测。样本若检测到至少一种HR-HPV或可能的HR-HPV型，则分类为HR-HPV阳性。
纳入的734名女性中，722名有完整的HPV数据。ccc-LIQ样本中20.9%检测到HR-HPV。vsc-DRY样本检测HR-HPV的估计灵敏度和特异性分别为88.7%和92.5%，vsc-LIQ样本分别为87.4%和90.9%。79名女性（10.9%）的细胞学检查结果异常：在27份低级别鳞状上皮内病变样本中，vsc-DRY、vsc-LIQ和ccc-LIQ样本中有25份为HR-HPV阳性。在6份高级别鳞状上皮内病变样本中，vsc-DRY样本全部为HR-HPV阳性，vsc-LIQ样本中有1份为HR-HPV阴性，ccc-LIQ样本中有1份为HR-HPV阴性。
与宫颈临床医生采集样本相比，使用干拭子进行阴道自我采样检测HR-HPV感染的准确性较高，与细胞学检查结果相比也较为准确。这种廉价且易于运输的采样方法可广泛应用于宫颈癌筛查项目。
