Diagnostic accuracy of self-collected menstrual blood for high-risk human papillomavirus testing for cervical intraepithelial neoplasia and cervical cancer: a systematic review and meta-analysis

Introduction: Human papillomavirus (HPV) test is the most commonly used method for cervical cancer screening, but the participation rates remain low in many countries. Self sampling menstrual blood (MB) high-risk HPV (hr-HPV) test may offer a solution to this issue. The aim of this meta-analysis was to examine the accuracy of MB HPV test in detecting cervical cancer and cervical intraepithelial neoplasia (CIN). Methods: Electronic databases (PubMed, Embase, and Cochrane) were searched for articles published through October 23, 2024, with the following search terms: (men strual blood OR menstruation) AND (human papillomavirus). Observational studies (e.g., cross-sectional studies, retrospective studies and prospective studies) that reported cervical histopathological biopsy outcomes in women undergoing self-sampling MB HPV testing were included. Data extraction was performed by two independent reviewers according to the PRISMA guidelines. Meta-analyses were conducted based on sensitivities and specificities and corresponding 95% Confidence intervals (CIs) using bivariate random-effects model and hierarchical summary receiver operating characteristic (HSROC) model. The risk of publication bias and heterogeneity were also assessed. Data were analyzed from October to November 2024. Results: = 98.24), respectively. Discussion: The evidence from this meta-analysis, which includes women with and without CIN and cervical cancer, shows the high sensitivity and low specificity of the MB hrHPV test. Further large-scale diagnostic studies that combine multiple testing modalities are recommended to support and validate the application of the MB hrHPV test. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024605195, Identifier CRD42024605195.