TY - JOUR
T1 - Evaluation of self-collected vaginal specimens for the detection of high-risk human papillomavirus infection and the prediction of high-grade cervical intraepithelial lesions in a high-burden, low-resource setting
AU - Toliman, P. J.
AU - Kaldor, J. M.
AU - Badman, S. G.
AU - Phillips, S.
AU - Tan, G.
AU - Brotherton, J. M.L.
AU - Saville, M.
AU - Vallely, A. J.
AU - Tabrizi, S. N.
PY - 2019/4
Y1 - 2019/4
N2 - Objectives: To compare the performance of self-collected vaginal (V) specimens with clinician-collected cervical (C) specimens for detection of high-risk human papillomavirus (hrHPV) and cervical disease using the Cepheid Xpert HPV, Roche Cobas 4800 HPV and Hologic Aptima HPV assays. Methods: Women aged 30–59 years (n = 1005) were recruited at two clinics in Papua New Guinea, and they provided specimens for testing at point-of-care using the Xpert HPV Test, and for subsequent testing using the Cobas HPV (n = 981) and Aptima HPV (n = 983) assays. Liquid-based cytology was performed on C specimens to predict underlying high-grade squamous intraepithelial lesions (HSIL). V specimen results of each assay were evaluated against a constructed reference standard and for detection of HSIL or worse. Results: There was substantial (κ >0.6) agreement in hrHPV detection between V and C specimens across all three assays. The sensitivity, specificity, and positive and negative predictive values of Xpert HPV using self-collected V specimens for the detection of HPV type 16 according to the constructed reference standard were 92.1%, 93.1%, 63.6% and 98.9%, respectively; compared with 90.4%, 94.3%, 67.8% and 98.7% for Cobas 4800 HPV; and 63.2%, 97.2%, 75.0% and 95.3% for Aptima HPV. Similar results were observed for all hrHPV types (combined) and for HPV types 18/45, on all three assays. The detection of any hrHPV using self-collected specimens had high sensitivity (86%–92%), specificity (87%–94%) and negative predictive value (>98%) on all assays for HSIL positivity. Conclusions: Xpert HPV, using self-collected vaginal specimens, has sufficient accuracy for use in point-of-care ‘test-and-treat’ cervical screening strategies in high-burden, low-resource settings.
AB - Objectives: To compare the performance of self-collected vaginal (V) specimens with clinician-collected cervical (C) specimens for detection of high-risk human papillomavirus (hrHPV) and cervical disease using the Cepheid Xpert HPV, Roche Cobas 4800 HPV and Hologic Aptima HPV assays. Methods: Women aged 30–59 years (n = 1005) were recruited at two clinics in Papua New Guinea, and they provided specimens for testing at point-of-care using the Xpert HPV Test, and for subsequent testing using the Cobas HPV (n = 981) and Aptima HPV (n = 983) assays. Liquid-based cytology was performed on C specimens to predict underlying high-grade squamous intraepithelial lesions (HSIL). V specimen results of each assay were evaluated against a constructed reference standard and for detection of HSIL or worse. Results: There was substantial (κ >0.6) agreement in hrHPV detection between V and C specimens across all three assays. The sensitivity, specificity, and positive and negative predictive values of Xpert HPV using self-collected V specimens for the detection of HPV type 16 according to the constructed reference standard were 92.1%, 93.1%, 63.6% and 98.9%, respectively; compared with 90.4%, 94.3%, 67.8% and 98.7% for Cobas 4800 HPV; and 63.2%, 97.2%, 75.0% and 95.3% for Aptima HPV. Similar results were observed for all hrHPV types (combined) and for HPV types 18/45, on all three assays. The detection of any hrHPV using self-collected specimens had high sensitivity (86%–92%), specificity (87%–94%) and negative predictive value (>98%) on all assays for HSIL positivity. Conclusions: Xpert HPV, using self-collected vaginal specimens, has sufficient accuracy for use in point-of-care ‘test-and-treat’ cervical screening strategies in high-burden, low-resource settings.
KW - Cervical cancer
KW - HPV
KW - Point-of-care
KW - Self-collect
KW - Vaginal specimens
UR - http://www.scopus.com/inward/record.url?scp=85046787265&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2018.05.025
DO - 10.1016/j.cmi.2018.05.025
M3 - Article
C2 - 29906593
AN - SCOPUS:85046787265
SN - 1198-743X
VL - 25
SP - 496
EP - 503
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 4
ER -