HPV testing of self-samples: Influence of collection and sample handling procedures on clinical accuracy to detect cervical precancer

We applaud Inturrisi et al. for their report describing the first findings of the pioneering HPV-based Dutch cervical cancer screening programme. 1Since 2018, women living in the Netherlands who are due to screening receive an invitation to contact their general physician for the collection of a liquid cervical specimen.Non-responders receive a second invitation to request a vaginal self-sampling device and those who confirm this option, receive an Evalyn-Brush (Rovers Medical Devices, Oss, the Netherlands) at their home address (opt-in procedure).Used vaginal brushes are sent to one of the five HPV screening laboratories where they are transferred into 20 mL of PreservCyt liquid (Hologic Inc, Bedford, MA, USA).Eight percent of women not responding to the primary invitation requested and performed self-sampling.The proportion of women with a hrHPV positive result was 7.4% and 9¢3%, in the cohorts with a self-sample (SS cohort) and a cliniciancollected specimen (CS cohort), respectively (ratio of 0¢79).The Dutch study revealed obvious differences between self-and clinician-samples with respect to the used Cobas-4800 PCR test (Roche, Pleasanton, CA, USA) signal strength expressed in Ct values, which reflect differences in viral load (known to be lower in the vaginal environment than in scraped cervical cells) yielding lower analytical sensitivity.Using the default cut-off predefined by the manufacturer for both type of specimens, the estimated relative clinical sensitivity and relative specificity, accounting for confounding factors, for CIN3+ were 0.94 and 1¢02, respectively.