de Melo Kuil Larissa, Lorenzi Adriana Tarla, Stein Maíra Degiovani, Resende Júlio César Possati, Antoniazzi Márcio, Longatto-Filho Adhemar, Scapulatempo-Neto Christóvam, Fregnani José Humberto Tavares Guerreiro
Center for Research Support, Barretos Cancer Hospital, Pius XII Foundation, Barretos, Brazil.
Acta Cytol. 2017;61(6):425-433. doi: 10.1159/000477331. Epub 2017 Jun 1.
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.
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.
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.
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.
在巴西女性群体中，比较使用两种不同采集方式（自我采集（阴道灌洗）和宫颈巴氏试验）获取的样本进行宫颈细胞学检查和高危型人乳头瘤病毒（HPV）检测的结果。
我们招募了204名年龄在18 - 64岁之间且先前宫颈细胞学检查结果异常的女性；其中83.8%同意参与。样本被分成两份：一份用于细胞学研究，一份用于高危型HPV的分子分析。
58%的参与者更倾向于采用自我采集作为替代筛查方法。然而，我们注意到，与使用传统采集方法获得的样本相比，自我采集样本中的HPV阳性率显著更低（p = 0.035）。通过自我采集获得的样本的细胞学检查具有敏感性，但其阳性预测值和曲线下面积（AUC）显著低于巴氏试验。不过，这些检查的特异性和阴性预测值相似。与HPV检测相比，自我采集样本在预测高级别宫颈上皮内瘤变或更严重病变方面准确性较低，其敏感性、阳性预测值和AUC均显著低于宫颈巴氏试验样本。
阴道灌洗自我采集简单且女性接受度良好。然而，由于其局限性，灌洗自我采集应谨慎使用。
