Detecção molecular do HPV em amostras não invasivas: revisão de escopo sobre a acurácia e aplicabilidade no rastreamento do câncer cervical

Abstract

Cervical cancer, primarily caused by Human Papillomavirus (HPV), remains a global public health challenge, requiring strategies to increase screening adherence in line with the WHO 2030 targets. Objectives: To map evidence on the accuracy and applicability of HPV detection by PCR in non-invasive samples (urine and vaginal) compared to clinical cervical collection. Methods: A scoping review was conducted following the PRISMA-ScR and Arksey & O’Malley guidelines. Searches were performed in MEDLINE, Embase, Web of Science, and Cochrane Library databases using the descriptors: Urine, Urine Specimen, Urine Collection, Papillomavirus, Papillomavirus Infections, Human Papillomavirus, HPV, Vagina, Vaginal, Vaginal Smears, PCR, Polymerase Chain Reaction, Cervical Cells, Cervix, Sensitivity, Specificity, and Diagnostic Accuracy for studies published until December 2025. The protocol was registered on the OSF platform. Results: Eight studies (2016-2024) were included. Vaginal self-sampling showed performance equivalent to clinical collection, with sensitivity >80% and agreement >70%. Urine samples presented sensitivity ranging from 44.4% to 98.2% and specificity from 60% to 100%, with higher accuracy observed in first-void samples and for high risk genotypes (HPV 16/18). The predominant genetic target was the L1 gene. Conclusion: HPV detection by PCR in non-invasive samples has significant potential to complement or replace the traditional method. Vaginal self-sampling and clinical cervical samples are consolidated and effective methods. Although urine samples still require standardization, they are a promising alternative to expand screening in populations with low adherence, contributing to the WHO cervical cancer elimination goals.