Evaluation Of Thinprep Cytology, Hpv, Terc Gene, C-MYC Gene, VIA/VILI Terting In The Cervical Cancer Screening

Objectives:To evaluate thinprep cytology, HPV, TERC gene, C-MYC gene, VIA/VILI as cervical cancer screening methods, explore the more effective screening methods.Materials and Methods:The study population comprised700patients at gynaecology district, and agree to attend the opportunistic cervical cancer screening. Specimen collection was started in November2010and was completed in July2011. Both the patients were detected with TCT, HPV, TERC gene, C-MYC gene, VIA/VILI, with the histopathologic diagnosis for gold standard. Comparison of five screening methods to identify high-grade cervical lesions (≥CIN Ⅱ), the performance indexes of algorithms such as sensitivity, specificity, false positive rate, false negative rate, accuracy rate, positive likelihood ratio, negative likelihood ratio and receiver operating characteristic (ROC) curve. Compare the correlation between the five screening methods, as well as the correlation between the screening methods and pathology. In the different age groups, compare the methods to identify high-grade cervical lesions (≥CINⅡ) the accuracy of analysis. Use SAS8.0software to build joint diagnostic model, screening out the model indicators (TCT, HPV) combining the screening tests in parallel or in serial, comparative analysis income program to identify high-grade cervical lesions (≥CINⅡ) accuracy. Results:1. Overall performance of five screening tests:TCT, HPV, TERC gene, C-MYC gene, VIA/VILI alone screening≥CINII lesions of sensitivity, specificity:80.9%,70.2%,72.3%,76.6%,72.3%;98.0%,95.1%,96.3%,96.3%,90.4%, respectively. Cervical cancer is the most common of HPV16type infection, while HPV16,58and52type infection are the majority of CINII-Ⅲ.2. Correlation analysis:The correlation between the five screening indicators and between the screening indicators and pathological level (P<0.05). HPV infection showed an increasing trend in the cytological classification, and TERC, C-MYC amplification amplifies were significantly higher than≤HSIL lesions in SCC lesions (P<0.05). In33cases of HPV infection in high-grade cervical lesions, TERC, C-MYC gene amplification rate of69.70%(23/33),72.73%(24/33), respectively. In34cases of TERC gene amplification and36cases of C-MYC gene amplification in high-grade cervical lesions, HPV infection rate of67.65%(23/34),66.67%(24/36), respectively.3. In25to34years old,35to44years,45to54years old,55to64years old four groups, TCT, HPV, VIA/VILI screening≥CI Ⅱ lesions of sensitivity:64.3%,90.9%,76.5%,85.7%and78.6%,72.7%,60.0%,71.4%and85.7%,81.8%,66.7%,42.9%. The specificity of these indicators were:98.9%,98.1%,98.8%,95.2%and96.7%,95.1%,92.2%,100%and91.2%,90.5%,89.8%,88.1%.4. Combination of screening:The established mathematical diagnosis model is:Logit(P)=5.757-4.055×TCT-3.724×HPV. Amory the algorithms combined by TCT and HPV testing, the sensitivity, specificity were78.7%and99.5%for the algorithm of TCT as primary screening test, with ASCUS women triage by HPV testing;53.2%and99.7%for the algorithm of HPV as primary screening test, with HPV positive women triage by TCT testing;97.9%and 93.4%for the combination in parallel. TCT combined HPV in parallel was better than TCT primary testing followed by HPV triage and HPV primary testing followed by TCT triage (AUCTCT plus HPV=0.956; AUCTCT with reflex HPV=0.891; AUCHPV with reflex TCT=0.764).Conclusions:1. In five screening methods, the TCT diagnosis of high-grade cervical lesion with high accuracy, but it is subject to sampling and reading the slides. Women mostly HPV infection is one off, that the sensitivity of HPV screening is not high. HPV16type is the pathogenic form of cervical cancer, while the high-grade squamous intraepithelial lesions is HPV16、58and52tepe of infection-based. HPV58,52infection should pay attention to the follow-up. As a separate screening, TERC gene or C-MYC gene was not show obvious superiority. VIA/VILI is simple, but is subjective, needs intense training to improve its sensitivity and specificity. In all ages, VIA/VILI screening effects are inconsistent, and not recommended for menopausal and perimenopausal women.2. HPV infection can lead to TERC and C-MYC gene amplification, but it is not the only reason, there are other reasons also involved in gene amplification. Joint detection of the expression of the three indicators plays an important role in cervical cancer screening, early diagnosis and treatment, and estimating prognosis.3. Opportunistic screening is a practical and feasible method to improve the efficiency of cervical cancer screening. TCT combined HPV in parallel is suitable for developed regions, moderately developed regions may choose TCT primary testing followed by HPV triage, TCT alone testing is a suitable primary screening test in less developed regions. VIA/VILI can be carried out in some remote and economically backward areas. Objectives:To evaluate the diagnostic value of TERC gene, C-MYC gene on high grade squamous ontraepithelial lesion of cervix.Methods:We search Pubmed, EMbase, Cochrane Library, RBMR, etc, from can check date to March31,2012. We evaluate documents quality base on the diagnostic test accuracy quality evaluation tools (QUADAS) and the studies meet the requirements were extracted, data analysis was conducted by Meta-Disc1.4software.Result:12studies with a total of7894cases in TERC gene were included, and C-MYC gene of7studies with a total of1180cases. The results of meta-analysis showed that the sensitivity, specificity, diagnostic odds ratio of TERC gene on high grade squamous ontraepithelial lesion of cervix were0.81(95%CI0.80-0.82),0.83(95%CI0.82-0.84),17.37(95%CI8.77-34.41), respectively. The C-MYC gene of these indicators were:0.52(95%CI0.47-0.57),0.80(95%CI0.77-0.83),3.60(95%CI1.55-8.39).Conclusions:TERC gene has higher sensitivity than C-MYC gene in diagnose of cervical lesions, but the specificity both quite. Diagnosis value of both genes were medium in alone diagnosis high grade squamous ontraepithelial lesion of cervix, and both can be used as auxiliary other clinical diagnosis method of a kind of optional methods.