Urinary HPV Testing for Presence of Cervical HPV
Urinary HPV Testing for Presence of Cervical HPV
Objective To determine the accuracy of testing for human papillomavirus (HPV) DNA in urine in detecting cervical HPV in sexually active women.
Design Systematic review and meta-analysis.
Data sources Searches of electronic databases from inception until December 2013, checks of reference lists, manual searches of recent issues of relevant journals, and contact with experts.
Eligibility criteria Test accuracy studies in sexually active women that compared detection of urine HPV DNA with detection of cervical HPV DNA.
Data extraction and synthesis Data relating to patient characteristics, study context, risk of bias, and test accuracy. 2×2 tables were constructed and synthesised by bivariate mixed effects meta-analysis.
Results 16 articles reporting on 14 studies (1443 women) were eligible for meta-analysis. Most used commercial polymerase chain reaction methods on first void urine samples. Urine detection of any HPV had a pooled sensitivity of 87% (95% confidence interval 78% to 92%) and specificity of 94% (95% confidence interval 82% to 98%). Urine detection of high risk HPV had a pooled sensitivity of 77% (68% to 84%) and specificity of 88% (58% to 97%). Urine detection of HPV 16 and 18 had a pooled sensitivity of 73% (56% to 86%) and specificity of 98% (91% to 100%). Metaregression revealed an increase in sensitivity when urine samples were collected as first void compared with random or midstream (P=0.004).
Limitations The major limitations of this review are the lack of a strictly uniform method for the detection of HPV in urine and the variation in accuracy between individual studies.
Conclusions Testing urine for HPV seems to have good accuracy for the detection of cervical HPV, and testing first void urine samples is more accurate than random or midstream sampling. When cervical HPV detection is considered difficult in particular subgroups, urine testing should be regarded as an acceptable alternative.
Human papillomavirus (HPV) is one of the commonest sexually transmitted infections. Up to 80% of sexually active women are infected at some point in their lives and 10-20% develop persistent infection. Infection with specific strains of HPV has been associated with the development of cervical cancer, a preventable and treatable disease for which routine screening using a cervical cytology based method is employed to detect precancerous cervical intraepithelial neoplasia (CIN). Despite screening, cervical cancer is still the most common malignancy in women aged less than 35, and there has been a downward trend in coverage of screening in this population. This may partly be because the current screening by cervical cytology sampling is invasive, is time consuming, and requires a clinician.
The detection of HPV in the cervix is being piloted as a new method of cervical cancer screening and is recommended for secondary prevention. This is based on four randomised controlled trials and a pooled analysis of these, which showed that HPV detection is more protective against grade 3 CIN and invasive cervical cancer compared with current screening methods. However, cervical HPV detection shares many of the problems of current cytology based screening programmes. It is still invasive and time consuming and is unlikely to resolve the problem of poor screening uptake. Detection of HPV in urine would offer a more accessible and acceptable method. It could also be used for post-vaccination HPV surveillance programmes, where pelvic examination is not practical. Published reviews assessing detection of urine HPV conclude that urine sampling is a feasible alternative to cervical sampling. However, they do not include a meta-analysis of test accuracy. We conducted a systematic review and meta-analysis to determine the accuracy of detection of HPV in urine compared with the cervix in sexually active women.
Abstract and Introduction
Abstract
Objective To determine the accuracy of testing for human papillomavirus (HPV) DNA in urine in detecting cervical HPV in sexually active women.
Design Systematic review and meta-analysis.
Data sources Searches of electronic databases from inception until December 2013, checks of reference lists, manual searches of recent issues of relevant journals, and contact with experts.
Eligibility criteria Test accuracy studies in sexually active women that compared detection of urine HPV DNA with detection of cervical HPV DNA.
Data extraction and synthesis Data relating to patient characteristics, study context, risk of bias, and test accuracy. 2×2 tables were constructed and synthesised by bivariate mixed effects meta-analysis.
Results 16 articles reporting on 14 studies (1443 women) were eligible for meta-analysis. Most used commercial polymerase chain reaction methods on first void urine samples. Urine detection of any HPV had a pooled sensitivity of 87% (95% confidence interval 78% to 92%) and specificity of 94% (95% confidence interval 82% to 98%). Urine detection of high risk HPV had a pooled sensitivity of 77% (68% to 84%) and specificity of 88% (58% to 97%). Urine detection of HPV 16 and 18 had a pooled sensitivity of 73% (56% to 86%) and specificity of 98% (91% to 100%). Metaregression revealed an increase in sensitivity when urine samples were collected as first void compared with random or midstream (P=0.004).
Limitations The major limitations of this review are the lack of a strictly uniform method for the detection of HPV in urine and the variation in accuracy between individual studies.
Conclusions Testing urine for HPV seems to have good accuracy for the detection of cervical HPV, and testing first void urine samples is more accurate than random or midstream sampling. When cervical HPV detection is considered difficult in particular subgroups, urine testing should be regarded as an acceptable alternative.
Introduction
Human papillomavirus (HPV) is one of the commonest sexually transmitted infections. Up to 80% of sexually active women are infected at some point in their lives and 10-20% develop persistent infection. Infection with specific strains of HPV has been associated with the development of cervical cancer, a preventable and treatable disease for which routine screening using a cervical cytology based method is employed to detect precancerous cervical intraepithelial neoplasia (CIN). Despite screening, cervical cancer is still the most common malignancy in women aged less than 35, and there has been a downward trend in coverage of screening in this population. This may partly be because the current screening by cervical cytology sampling is invasive, is time consuming, and requires a clinician.
The detection of HPV in the cervix is being piloted as a new method of cervical cancer screening and is recommended for secondary prevention. This is based on four randomised controlled trials and a pooled analysis of these, which showed that HPV detection is more protective against grade 3 CIN and invasive cervical cancer compared with current screening methods. However, cervical HPV detection shares many of the problems of current cytology based screening programmes. It is still invasive and time consuming and is unlikely to resolve the problem of poor screening uptake. Detection of HPV in urine would offer a more accessible and acceptable method. It could also be used for post-vaccination HPV surveillance programmes, where pelvic examination is not practical. Published reviews assessing detection of urine HPV conclude that urine sampling is a feasible alternative to cervical sampling. However, they do not include a meta-analysis of test accuracy. We conducted a systematic review and meta-analysis to determine the accuracy of detection of HPV in urine compared with the cervix in sexually active women.
