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Shanxi Province cervical cancer screening study II: Self-sampling for high-risk human papillomavirus compared to direct sampling for human papillomavirus and liquid based cervical cytology
  1. J. L. Belinson*,
  2. Y. L. Qiao,
  3. R. G. Pretorius,
  4. W. H. Zhang,
  5. S. D. Rong,
  6. M. N. Huang,
  7. F. H. Zhao,
  8. L. Y. Wu,
  9. S. D. Ren§,
  10. R. D. Huang,
  11. M. F. Washington*,
  12. Q. J. Pan,
  13. L. Li and
  14. D. Fife*
  1. * Cleveland Clinic Foundation, Cleveland, Ohio
  2. The Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China
  3. Kaiser Permanente Fontana, California
  4. § Xiangyuan Women and Children Hospital, Shanxi, China
  5. Yangcheng Cancer Institute/Hospital, Shanxi, China
  1. Address correspondence and reprint requests to: from China: Youlin Qiao, Cancer Institute, Chinese Academy of Medical Sciences, Beijing 100021, China; or from all other countries: Jerome L. Belinson, The Cleveland Clinic Foundation, Department of Obstetrics and Gynecology, 9500 Euclid Ave. A-81, Cleveland, Ohio 44195, USA. E-mail: belinsj{at}


The objective of this study was to compare the sensitivity and specificity of a new method for self-sampling for high risk human papillomavirus (HPV) with direct sampling and liquid based cervical cytology. In Shanxi Province, China, 8,497 women (ages 27–56) underwent a self-sample for HPV using a conical-shaped brush placed into the upper vagina and rotated. Three to sixteen months later the women were screened with liquid-based cytology and direct HPV tests. Subjects with any abnormal test underwent colposcopy and multiple biopsies. Mean age was 40.9 years. 4.4 percent of subjects had ≥CIN II, 26% a positive self-sample and 24% a positive direct test for HPV. The sensitivity for detection of ≥CIN II was 87.5% for self-sampling, and 96.8% for the direct test (P < 0.001). The specificity was 77.2% for the self-sample and 79.7% for the direct test. With an abnormal Pap defined as ASCUS or greater the sensitivity of the Pap for the detection of ≥ CIN II was 88.3% and the specificity was 81.2%. We conclude that self-sampling for HPV is less sensitive for ≥ CIN II than the direct test, but similar to liquid based cytology.

  • cervical cancer screening
  • HPV self-sampling
  • HPV testing
  • liquid based cytology

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