Accuracy analysis of cervical cancer screening using urine and vaginal self-sampling versus clinician-collected samples: A systematic review and meta-analysis.

OBJECTIVE

The aim of the present study was to explore the differences in diagnostic performance between vaginal self-sampling, urine self-sampling, and clinician sampling in cervical cancer screening.

METHODS

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020, we searched PubMed, Cochrane Library, Web of Science, and Embase. Study quality was assessed with Cochrane Review Manager 5.3. Diagnostic performance was evaluated by pooling sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve using STATA 18.0.

RESULTS

The meta-analysis included 15 studies with 3665 participants, all with abnormal cervical cancer screening results. The pooled sensitivity for both self-sampling methods was 0.88 (95% confidence interval [CI]: 0.85, 0.91), the pooled specificity was 0.81 (95% CI: 0.68, 0.89), and the area under the curve (AUC) was 0.92 (95% CI: 0.89, 0.94). For high risk-human papillomavirus (HR-HPV), vaginal self-sampling showed a sensitivity of 0.92 (95% CI: 0.90, 0.94) and specificity of 0.80 (95% CI: 0.58, 0.92), and AUC was 0.93 (95% CI: 0.91, 95); urine self-sampling showed a sensitivity of 0.83 (95% CI: 0.77, 0.88) and specificity of 0.81 (95% CI: 0.65, 0.91), and AUC was 0.88 (95% CI: 0.85, 0.91). For >CIN2 lesions, vaginal self-sampling showed a sensitivity of 0.98 (95% CI: 0.96, 0.99) and specificity of 0.63 (95% CI: 0.48, 0.77), and AUC was 0.98 (95% CI: 0.96, 0.99); urine self-sampling showed a sensitivity of 0.95 (95% CI: 0.91, 0.97) and specificity of 0.62 (95% CI: 0.31, 0.86), and AUC was 0.95 (95% CI: 0.93, 0.97).

CONCLUSION

Vaginal and urine self-sampling for HPV testing show promising diagnostic potential, with vaginal sampling outperforming urine. Both methods have similar sensitivity for detecting lesions >CIN2.