Cervical Cancer Screening: Vaginal Self-Sampling Outshines Urine in Accuracy, Study Finds

The study highlights the potential of self-collected samples as a viable alternative to clinician-collected cervical samples, especially in increasing participation in cervical cancer screening programs.

"Vaginal and urine self-sampling showed strong diagnostic accuracy for cervical cancer detection across 15 studies, with both methods reporting high sensitivity (0.88), specificity (0.81), and AUC (0.92)," the researchers reported. "Vaginal self-sampling outperformed urine in detecting high-risk HPV (sensitivity 0.92 vs. 0.83; AUC 0.93 vs. 0.88). It also showed superior sensitivity (0.98) for identifying lesions >CIN2."

Dong-mei Li, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China, and colleagues systematically analyzed data from 15 studies involving 3,665 women, all of whom had previously received abnormal cervical cancer screening results. Using rigorous methods outlined by PRISMA 2020 guidelines, data were pooled and analyzed to compare the sensitivity, specificity, and overall diagnostic performance, measured by the area under the receiver operating characteristic (ROC) curve, of the different sample collection approaches.

The key findings include the following:

• Both vaginal and urine self-sampling methods showed high diagnostic accuracy for cervical cancer screening.
• Overall, self-sampling methods had a pooled sensitivity of 88%, a specificity of 81%, and an AUC of 0.92.
• Vaginal self-sampling demonstrated better performance in detecting high-risk human papillomavirus (HR-HPV), with a sensitivity of 92% and an AUC of 0.93.
• Urine self-sampling for HR-HPV showed a sensitivity of 83% and an AUC of 0.88.
• The specificity for HR-HPV detection was nearly the same for both methods, around 80–81%.
• Vaginal self-sampling showed a sensitivity of 98% and an AUC of 0.98 in identifying cervical lesions graded >CIN2.
• Urine self-sampling for >CIN2 lesions demonstrated a sensitivity of 95% and an AUC of 0.95.
• Both sampling techniques had similar specificity for detecting >CIN2 lesions, approximately 62–63%.

The findings support the use of self-sampling as a credible and convenient option for cervical cancer screening, particularly in settings where access to clinician-based testing is limited or where cultural barriers discourage clinical visits. The higher diagnostic accuracy of vaginal self-sampling may make it the preferred method in such contexts.

The researchers note that by offering women more autonomy and privacy in the screening process, self-collection methods have the potential to increase participation rates, facilitate early detection, and ultimately reduce the global burden of cervical cancer.

"Overall, the study reinforces that while both self-sampling techniques are effective, vaginal self-sampling slightly edges out the urine-based collection in diagnostic accuracy, especially for high-risk HPV detection and precancerous lesions," they concluded.

Reference:

Zeng, X., & Lian, R. Accuracy analysis of cervical cancer screening using urine and vaginal self-sampling versus clinician-collected samples: A systematic review and meta-analysis. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.70207