Diagnostic Test Evaluation of Urine and Clinical Swab HPV Tests for Detection of HPV DNA and Pre-Invasive Cervical Lesions in Women in Senegal, 1998 - 2001

Abstract

Cervical cancer remains a significant health challenge, particularly in Western Africa, where resources for screening are limited. This cross-sectional study evaluated the efficacy of urine HPV tests compared to swab HPV tests as diagnostic and screening tools for cervical cancer among 1,397 women aged 35 to 80 attending health centers in Dakar, Senegal, from 1998 to 2001. Participants underwent cytology, urine HPV testing, and clinical swab HPV testing, with follow-up biopsies for a subset. Urine samples were collected using a void catch-free method, and cervical samples were collected via cervical swabs preserved in PreservCyt. The study employed the PCR Roche Linear Array to detect 27 HPV types and compared the sensitivity and specificity of urine and swab samples.The overall prevalence of HPV was higher in swab samples (17.8%) than in urine samples (12.9%). The sensitivity of urine testing for detecting any HPV present in swab samples was 39.5%, with a specificity of 92.9%. For high-risk HPV types, urine samples exhibited a sensitivity of 27.2% and a specificity of 98.8%. The sensitivity of urine HPV tests for detecting high-grade squamous intraepithelial lesions (HSIL) or invasive cancer was 33.3%, compared to 74.1% for swab HPV tests, though both methods showed high specificity. Age-stratified analysis (±45 years) indicated no statistical difference in the sensitivities between age groups. This study's strengths include its large sample size, robust laboratory methodology, and the novel examination of urine and cervical swab analyses within a West African population. Limitations include potential variability in sample collection timing and using a void-free catch method for urine sampling. Future research should focus on refining urine collection methods and implementing more advanced testing technologies to maximize screening accuracy.