Meta-analysis finds HPV testing sensitivity for HSIL+ is 84.5% with urine versus 92.1% with cervical specimens.

OBJECTIVES: Self-collection is a strategy to facilitate HPV testing with the objective of eliminating cervical cancer, as set by the World Health Organization for completion by 2030. Using urine samples for HPV testing offers the advantages of being noninvasive and eliminating barriers to screening. However, concerns remain regarding its accuracy. Therefore, the meta-analysis focused on verifying the comparative effectiveness of HPV testing using self-collected urine specimens versus physician-collected cervical specimens. METHODS: A search of PubMed, Embase, and the Cochrane Library databases was conducted to identify studies of HPV testing. The studies incorporated within the current meta-analysis evaluated the diagnostic accuracy of HPV testing for high-grade squamous intraepithelial lesion or worse (HSIL+) with self-collected urine specimens in comparison with physician-collected cervical specimens. Furthermore, studies that offered explicit data to facilitate meta-analysis were also included. The meta-analysis was conducted using a bivariate random-effects model. RESULTS: A total of 23 articles were identified, including 8,332 self-collected urine and 8,324 physician-collected cervical samples. The meta-analysis yielded a pooled sensitivity of 84.5% of HPV testing with self-collected urine specimens, and another meta-analysis yielded a pooled sensitivity of 92.1% of HPV testing with physician-collected cervical specimens for HSIL+. The subgroup analysis revealed that first-void urine with Colli-Pee for evaluating HPV testing reported a pooled sensitivity of 87.8%. CONCLUSIONS: HPV testing with physician-collected cervical specimens achieves higher sensitivity for detecting HSIL+ compared with self-collected urine. First-void urine, using a standard collection device, may yield a marginally elevated level of sensitivity.