Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing?: A systematic review and meta-analysis

Objective. To compare the detection rate of genital human papillomavirus (HPV) infection in self- and physician-obtained samples. Design. Systematic review and meta-analysis. Data sources. Studies published between 1966 and November 2005 identified through Medline and Embase that compared both sampling methods. Main outcome measures. We calculated the concordance and kappa statistic between physician- and self-sampling and the difference between proportions of HPV positive samples. Weighted averages were reported with 95% confidence intervals (CI) using a random-effects model. Results. Eighteen studies (5441 participants) were included that evaluated broad HPV type categories, 10 (3688 patients) that of high-risk (HR) HPV and three (530) that of low-risk (LR) HPV A high level of concordance of 0.87 (95% CI, 0.82 to 0.91) between self- and physician-sampling was obtained for detection of HPV DNA (kappa 0.66, 95% CI, 0.56 to 0.76). The prevalence difference of HPV DNA between sampling methods was -0.5 (95% CI, -2.8 to 1.8). Results were similar when restricting the analysis to HR-HPV but the prevalence of LR-HPV types was higher in self-collected samples. Conclusion. Self-sampling was as sensitive as physician-obtained sampling to detect HR-HPV or HPV DNA. Self-sampling may be a suitable alternative method for studies on HPV transmission and vaccine trials. (C) 2007 Elsevier Inc. All rights reserved.