A new molecular-based approach to triaging HPV-positive cervicovaginal samples could pave the way for cervical cancer screening based entirely on self-sampling, researchers have claimed.
A study in this month’s The Lancet Oncology found the molecular technique detected CIN2 or worse on self-sampled specimens as accurately as standard cytology done on physician-collected samples.
Offering self-sampling for HPV testing can increase the number of women willing to take part in cervical screening programmes, but self-collected samples are not suitable for current cell-based tests used to triage those samples that turn out to be HPV positive.
Researchers in The Netherlands invited women who were unwilling to participate in cervical screening to provide a self-collected cervicovaginal sample for HPV testing.
They then randomly triaged the HPV-positive samples with the molecular technique – based on detection of DNA methylation in certain genes – or using standard cytology.
Importantly, the molecular technique was done on the same sample provided at baseline, whereas standard cytology required an additional physician-collected sample.
Out of a total of 46,001 women they invited, 12,819 returned self-sampled specimens, of which 1,038 tested positive for high-risk HPV.
The DNA methylation technique detected CIN2 or worse as sensitively as cytology, the researchers reported.
There were more referrals for colcoscopy in the molecular triage group – 55% were referred, compared with 29% of the cytology triage group.
However, the overall time to diagnosis was much shorter in the molecular group, at an average of 96 days compared with 158 days.
The team concluded: ‘Molecular triage of HPV-positive women by MAL/miR0124-2 methylation analysis on self-collected specimens opens the way to full molecular screening as a feasible alternative for cervical screening by a physician-taken sample.’
Lancet Oncol 2014; available online 14 January
