G2 Insider: Urine-Based Testing OK to Detect HPV

Urine testing is an acceptable alternative to detect cervical human papillomavirus (HPV), according to a review study published online Sept. 16 in the British Medical Journal. While testing first-void urine samples has the best accuracy, the authors caution that lack of standardized testing methods should be addressed prior to incorporating the method into cervical cancer screening guidelines.

While cervical cancer is largely preventable and treatable, screening for the malignancy may be limited due to the acceptability of the invasive nature of cervical cytology sampling, and access may be hampered by the need for a clinician. Urine-based testing may overcome these screening barriers. The authors say urine testing could also be used for post-vaccination HPV surveillance programs, where pelvic examination is not practical.

The U.K.-based researchers conducted a systematic literature review and meta-analysis of studies assessing urine test accuracy (HPV DNA) in sexually active women versus detection of cervical HPV DNA. Sixteen of the 21 identified articles (including 1,443 women) were included in the meta-analysis.

Most studies utilized conventional polymerase chain reaction (PCR) methods (n = 18) on first-void urine samples (n = 12), although the authors acknowledge that testing methods were not uniform. Two of the 21 studies used nested PCR and one used PCR-based DNA microarray. Three studies evaluated quantitative, real-time PCR and hybrid capture in addition to conventional PCR.

In pooled analysis, urine detection of any HPV had a sensitivity of 87 percent and specificity of 94 percent. For high-risk HPV strains, urine detection had a pooled sensitivity of 77 percent and specificity of 88 percent, while urine detection of just the high-risk strains HPV 16 and 18 had a pooled sensitivity of 73 percent and specificity of 98 percent. Sensitivity was significantly increased when urine samples were collected at first void versus at random or midstream.

“Sensitivity was moderate for detection of any HPV, high risk HPV, and HPV 16 and 18. The specificity for detection of HPV in urine was especially high for any HPV and the most oncogenic strains, HPV 16 and 18,” write the authors, led by Neha Pathak, from the London School of Medicine and Dentistry. “We agree with previous reviews that heterogeneous methods of urine testing affect the interpretation of pooled accuracy measures. . . . We therefore recommend the standardization of methods for urine testing to minimize variation before incorporating urinary detection of HPV into guidelines for cervical cancer screening.”


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