Is the paper-based card a reliable storage medium for self-sampling HPV tests? A scoping review

Objectives

Self-sampling devices and commercial Human Papillomavirus (HPV) tests are evolving. Despite the encouraging results of a “paper smear” in 2002, along with the advantages of its transportation, brushes are more commonly used than paper-based cards for self-sampling in HPV testing. Thus, the study aimed to investigate this technology and analyze its reliability.

Methods

A review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews, from August to October 2024, and updated in July 2025. Six databases - Pubmed, Embase, CINAHL, Cochrane, Scopus and China National Knowledge Infrastructure (CNKI) - were used to retrieve records, with search strings translated accordingly across them.

Results

Of 122 studies, 10 met the inclusion criteria and were considered for analysis. The study populations were predominantly at higher risk of HPV infection. The findings reveal an overall agreement range of 82.4 % to 93.3 % between self-collected samples on FTA elute (Flinders Technology Associates) card/cartridge and physician-collected samples, which is slightly inferior to that found for Evalyn Brush, the most popular self-collection device worldwide. There is a lack of standardized procedures in the diagnostic chain using paper-based cards, but the use of POI (Preventive Oncology International) card and Whatman 903 filter paper expand the potential scenario of alternative low cost devices.

Conclusions

Paper-based cards, particularly the FTA elute card/cartridge, show promising results for HPV self-sampling, with high concordance, sensitivity, and specificity. However, current evidence is limited by small sample sizes, heterogeneity across studies, and lack of standardized protocols, underscoring the need for further research to validate their reliability and expand their application in HPV testing and beyond.