Diagnostic accuracy of menstrual blood for human papillomavirus detection in cervical cancer screening: A systematic review and meta-analysis.

PURPOSE: Cervical cancer is a major global health burden, disproportionately affecting women in low- and middle-income countries (LMICs), where access to traditional human papillomavirus (HPV) screening is limited. Menstrual blood (MB), a non-invasive and passively collectable biospecimen, may offer a culturally acceptable alternative. This review evaluates the diagnostic accuracy of MB-based high-risk HPV detection compared to clinician-collected cervical samples. METHODS: We included diagnostic accuracy studies and randomized controlled trials (RCTs) evaluating self-collected MB for high-risk HPV detection in asymptomatic women aged 25-65 years. Eligible studies reported sensitivity, specificity, or 2×2 data using clinician-collected cervical samples as the reference. We searched PubMed, Embase, and Google Scholar up to July 7, 2025. Risk of bias was assessed via QUADAS-3, and a bivariate random-effects model estimated pooled sensitivity and specificity. Certainty of evidence was assessed using GRADE. RESULTS: Seven studies (n = 1,297 participants; 586 reference-positive, 711 reference-negative) met inclusion criteria. The pooled sensitivity and specificity of MB-based HPV testing were 0.86 (95% CI: 0.80-0.90) and 0.90 (95% CI: 0.72-0.97), respectively. The diagnostic odds ratio was 56 (95% CI: 19-166), and the area under the hierarchical SROC curve was 0.90 (95% CI: 0.87-0.92), indicating high overall diagnostic performance. However, high heterogeneity (I2 = 94%) and threshold effects were observed. No significant publication bias was detected (Deeks' p = 0.62). CONCLUSIONS: MB-based HPV testing demonstrates high diagnostic accuracy and emerges as a non-invasive alternative for cervical cancer screening, especially in underserved settings. Further validation in diverse populations is warranted.