Could urinalysis be an alternative to traditional HPV testing?

Testing urine may be an acceptable alternative for detecting human papillomavirus (HPV)-including HPV16 and HPV18-in certain patients, according to a systematic review and meta-analysis in The BMJ. However, the findings must be viewed with caution because the method is not yet consistent and reproducible.

Included in the analysis were 14 studies derived from 16 articles (n = 1443 women), most of which used polymerase chain reaction (PCR) methods on first-void urine samples. Pooled specificity for urine in detection of any HPV was 94% (95% confidence interval [CI] 82% to 98%) and pooled sensitivity was 87% (95% CI 78% to 92%). For high-risk HPV, the pooled rates were 88% for specificity (95% CI 58% to 97%) and 77% for sensitivity (95% CI 68% to 84%). For HPV 16 and 18, urine detection had a pooled specificity of 98% (95% CI 91% to 100%) and a pooled sensitivity of 73% (95% CI 56% to 86%). Sensitivity was higher for urine collected at first void than at random or during midstream (P = 0.004), based on metaregression.

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Although PCR was used to test samples in most of the studies, their settings and HPV testing platforms and conditions differed. The between-study variation in pooled sensitivities and specificities, the authors said, means that “all results must be interpreted with caution as they may have been overestimated or underestimated.”

The investigators concluded that urine-based testing of HPV should be considered an acceptable alternative to cervical cytology, particularly in populations that may be hard to reach otherwise. However, the results should be viewed with caution due to potential variations, including a lack of standardized method for urine testing.

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