Nasopharyngeal versus nasal swabs for detection of SARS-CoV-2: a systematic review

Abstract

Nasopharyngeal swabbing (NPS) coupled with RT-PCR is the current gold standard for detecting SARS-CoV-2 infections. However, numerous studies have recently demonstrated the advantages of alternative nasal specimen collection approaches over NPS specifically for COVID-19 diagnosis. The present review was conducted according to PRISMA guidelines and summarises the current literature to give a clear overview of nasal specimen collection methods for SARS-CoV-2 detection. Publications investigating NPS and at least one other form of nasal specimen collection in combination with RT-PCR for viral detection in the context of COVID-19 were assessed. We identified 425 articles and ultimately included 18 studies in this systematic review. The suitable publications evaluated different forms of nasal specimen collection, with anterior nasal swabbing (ANS) and midturbinate swabbing (MTS) being the most frequently examined techniques. The analysed studies report sensitivity and specificity results (74.59-96.2% and 97.9-100.0%, respectively) similar to those achieved via NPS, especially in the early stages of disease or when paired with an oropharyngeal swab. Results from these studies suggest that ANS and MTS are suitable alternatives to NPS for COVID-19 testing. Due to their ease of collection, ANS and MTS collection techniques may facilitate broader testing strategies and allow for economization of medical staff.

Comparison of the SARS-CoV-2 BD Veritor Nasal Antigen Test with Nasopharyngeal Reverse Transcription-PCR in Symptomatic Patients

“…Although BD Veritor was able to detect SARS-CoV-2 from the NP and OP samples, additional data are necessary to evaluate the test sensitivity and specificity in NP/OP samples in comparison to anterior nasal specimens. Of note, a recently published literature review reports similar sensitivity and specificity in respect to diagnostic results between different forms of upper respiratory specimens, including anterior nasal and nasopharyngeal swabbing ( 12 ).…”

Evaluation of a New Standardized Nasal Sampling Method for Detection of SARS-CoV-2 RNA via RT-PCR

“…Several other studies have evaluated the performance of nasal sampling for detection of SARS-CoV-2. Herein, differences in nasal sampling sensitivity ranging from 68% to 96% were reported when compared to nasopharyngeal sampling [ 10 , 11 , 12 ]. The sensitivity of 80.7% found in our study falls within this reported range.…”

Very High Negative Concordance Rate of RT-PCR for SARS-CoV-2 in Nasopharyngeal Swab and Tracheo-Bronchial Aspirate in Children

“…The NP swab is currently considered the “Gold Standard” for SARS-CoV-2 detection ( 8 , 9 ). NP swab can however give false negative results, sometimes also related to suboptimal sample collection, especially in children ( 10 ).…”