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||Comparison of HPV detection in urine, vulvar, and cervical samples from women attending a colposcopy clinic.
||Sahasrabuddhe VV, Gravitt PE, Dunn ST, Brown D, Allen RA, Eby YJ, Smith K, Zuna RE, Zhang RR, Gold MA, Schiffman M, Walker JL, Castle PE, Wentzensen N
||J Clin Microbiol
||2013 Nov 6
||CGB, EBP, HREB
||While urine-based sampling for HPV is being explored as a simple and non-invasive approach for cervical cancer screening, data comparing HPV genotyping in urine versus those in cellular sampling of the cervix and vulva, and their correlation with rigorously-confirmed cervical disease status are sparse. We performed HPV genotyping on voided-urine and clinician-collected vulvar and cervical samples from seventy-two women undergoing colposcopy. Although urine-based HPV carcinogenic HPV detection was lower (58.3%) than cervical (73.6%) and vulvar (72.1%) detection (p=0.05 and 0.07, respectively), the agreement of urine HPV with cervical and vulvar HPV was 'moderate' (Kappa: 0.55) and 'substantial' (Kappa: 0.62), respectively. Urine-based carcinogenic HPV detection had a clinical sensitivity of 80.8% (95%CI=60.7-93.5) and a specificity of 53.3% (95%CI=37.9-68.3) for diagnosing cervical intraepithelial neoplasia (CIN) grades 2/3 on histology; 90.0% of CIN grade 3 was positive for urine HPV. The corresponding sensitivity and specificity values for vulvar sampling were 92.0% (95%CI=74.0-99.0) and 40.5% (95%CI=25.6-56.7), and those for cervical sampling were 96.2% (95%CI=80.4-99.9) and 40.0% (95%CI=25.7-55.7) respectively. HPV16 was the most common carcinogenic genotype detectable in 25.0% of urine, 33.8% of vulvar, and 31.9% cervical samples overall, with prevalence increasing with cervical disease grade, regardless of the sampling method. Stronger cervical HPV PCR signal strengths were associated with increased frequency of urine HPV detection. In summary, the relatively lower detection rates but comparable clinical performance of urine-based HPV sampling underscores the need for larger studies to evaluate urine-based sampling for cervical cancer screening, epidemiologic studies, and for post-vaccination HPV disease surveillance.