The Diagnostic Value Of Human Papillomavirus E6/E7mRNA Test For Cervical Lesions

ObjectiveTo investigate the diagnostic value of human papillomavirus(HPV) E6/E7mRNA test forcervical lesions and provide the basis for its clinical application by detecting HPV E6/E7mRNA in cervical cell.MethodsFrom June2012to April2013,a total of720gynecological outpatients in***Hospital, whohad cervical inflammation, abnormal vaginal bleeding or discharge, received TCT and HPVDNA tests, and for those whose TCT≥ASC-US or (and)high-risk HPV DNA-positive had HPVE6/E7mRNA detection and histopathological examination. HPV E6/E7mRNA was detectedby QuantiVirus, and the expression level was observed at different levels of cervicallesions.With the pathology results as the standard, the ability of HPV E6/E7mRNA detection forthe diagnosis of CIN2+was evaluated by comparison with the HPV DNA test.Results1、In CIN and invasive cervical cancer, the positive rate of HPV E6/E7mRNA was78.7%,lower than that of HPV DNA (92.6%), the difference was statistically significant (P<0.01).In theCIN1, CIN2, CIN3and ICC group, the positive rates of HPV DNAwere82.4%,92.5%,95.9%and96.6%respectively, mRNA-positive rates were55.9%,80.0%,83.6%and89.7%.The moreseverity of cervical lesions,the higher positive rate of HPV DNA and mRNA.2、The sensitivity of HPV E6/E7mRNA detection for diagnosis of CIN2+was83.0%,lower than that of HPV DNA (94.5%), the difference was statistically significant (P<0.01). Thespecificity was51.1%, higher than that of HPV DNA (22.8%), the difference was statisticallysignificant (P<0.01). For the diagnose of CIN2+, the positive predictive value(PPV) of HPVDNA and HPV E6/E7mRNA were70.8%and77.0%respectively, the difference was notstatistically significant (P>0.05),the negative predictive value were67.7%and60.3%respectively,the difference was also not statistically significant (P>0.05)Through the areas of ROC for HPVE6/E7mRNA and HPV DNA were0.670and0.587respectively, so the accuracy of HPV E6/E7mRNA detection for CIN2+was higher than that of HPV DNA,the difference was statisticallysignificant (P<0.01). 3、In the normal (cervicitis), CIN1, CIN2, CIN3and ICC group,the median (interquartilerange) copies of HPV E6/E7mRNA were93.3(0.0~884.1) copies/ml,333.6(0.0~2484.2)copies/ml,1344.2(106.3~7576.9) copies/ml,1405.8(134.0~11657.3) copies/ml and3173.4(497.8~27440.3) copies/ml.The mRNA copies of different grades of cervical lesions overalldifference was statistically significant (P <0.05). The more severe cervical lesions, the highermRNA expression level.4、The common HPV subtypes were HPV16,18,52and58, the most common of which wasHPV16. in HPV16, The positive rates of mRNA in HPV16,18,52and58were78.2%,81.0%,72.2%and74.4%. In HPV16group,the PPV of mRNA was89.2%for the diagnosis of CIN2+while the misdiagnosis rate was8.8%; In HPV18group，the PPV of mRNA was88.2%for thediagnosis of CIN2+while the misdiagnosis rate was6.3%; In HPV52and HPV58group, the PPVof mRNA were61.5%and79.3%respectively,and the misdiagnosis rates were27.3%and17.9%respectively.ConclusionsThe expression level and positive rate of HPV E6/E7mRNA are increased with the severityof cervical lesions;The specificity and accuracy of HPV E6/E7mRNA detection are higher thanthose of HPV DNA for diaganosis of CIN2+, so HPV E6/E7mRNA detection has a certainapplication value for cervical lesions screening.