Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
Gynecol Oncol. 2022 Aug;166(2):358-368. doi: 10.1016/j.ygyno.2022.06.012. Epub 2022 Jun 30.
Cervical cancer still poses a considerable threat to women in low- and middle-income countries, particularly on the African continent. Self-collection of a vaginal sample promises advantages over the established sampling by clinicians. We aimed to assess the accuracy of self-sampling compared to clinician sampling in order to inform its application in primary care in the African context.
We searched Pubmed, Livivo, Web of Science, Cochrane Library and African Index Medicus on the 07th of February 2022. The eligibility criteria were: reporting (i) self-sampling against clinician-sampling, (ii) study location in Africa, (iii) relevant outcome-measures: (a) Cohen's kappa (b) sensitivity and specificity of self-sampling tests. We combined Cohen's kappa effects, additionally sensitivity and specificity estimates using random-effects models. The study is registered with PROSPERO (CRD42020218081).
We included 28 studies in the systematic review and 21 studies in the meta-analysis. Self-sampling was used to test for high-risk HPV infections. Two studies additionally tested for low-risk HPV infections. The pooled Cohen's kappa was 0.66 (95%CI: 0.61-0.71). Populations at risk yielded 0.63 (95%CI: 0.56-0.71). Target amplification tests based on PCR performed best with a kappa of 0.68 (95%CI: 0.63-0.73) compared to isothermal mRNA tests, 0.61 (95%CI: 0.51-0.71). Point of care tests performed exceptionally well, 0.73 (95%CI: 0.67-0.80). Sensitivities are close to 80% and specificities close to 90% of self-sampling to detect high-risk HPV.
Self-sampling agrees moderately to substantially with clinician sampling in the African context. Point of care tests might be particularly suited for application in cervical cancer primary screening in low- and middle-income countries. Populations at risk should get special attention while using self-sampling. Screening protocols should be established.
宫颈癌仍然对中低收入国家的妇女构成相当大的威胁，特别是在非洲大陆。与临床医生建立的采样方法相比，自我采集阴道样本具有优势。我们旨在评估自我采样与临床医生采样相比的准确性，以便为其在非洲背景下的初级保健中的应用提供信息。
我们于 2022 年 2 月 7 日在 Pubmed、Livivo、Web of Science、Cochrane Library 和 African Index Medicus 上进行了搜索。纳入标准为：（i）报告自我采样与临床医生采样的比较，（ii）研究地点在非洲，（iii）相关的结果测量：（a）科恩氏κ（b）自我采样检测的敏感性和特异性。我们使用随机效应模型组合科恩氏κ效应，以及敏感性和特异性估计值。该研究已在 PROSPERO（CRD42020218081）上注册。
我们在系统评价中纳入了 28 项研究，在荟萃分析中纳入了 21 项研究。自我采样用于检测高危 HPV 感染。有两项研究还测试了低危 HPV 感染。合并的科恩氏κ值为 0.66（95%CI：0.61-0.71）。高危人群的科恩氏κ值为 0.63（95%CI：0.56-0.71）。基于 PCR 的靶向扩增试验的κ值最高，为 0.68（95%CI：0.63-0.73），而等温 mRNA 试验的κ值为 0.61（95%CI：0.51-0.71）。即时检测的效果非常好，0.73（95%CI：0.67-0.80）。自我采样检测高危 HPV 的灵敏度接近 80%，特异性接近 90%。
自我采样在非洲背景下与临床医生采样中等度至高度一致。即时检测可能特别适合在中低收入国家进行宫颈癌的初级筛查。高危人群在使用自我采样时应特别注意。应制定筛查方案。
