| Objective:To investigate the value of HPV E6/E7 mRNA detection and TCT in cervical precancerous lesions and cervical cancer screening.Methods:A retrospective analysis of 5307 patients who underwent cervical precancerous lesions and cervical cancer screening at the Affiliated Hospital of Zunyi Medical University from June 2018 to June 2019 was selected.All cases underwent Aptima HPV E6/E7 mRNA detection,TCT,abnormal cases or the one was highly suspected cervical lesions by the clinician,after communication,informed consent,proceeded to be examined with colposcopy cervical biopsy.A total of 304 cases were included.Now discuss the following:1.The positive rate of HPV E6/E7 mRNA detection and TCT in different cervical lesions;The relationship with HPV E6/E7 mRNA detection subtype and severity of cervical lesions;Compare the diagnostic efficacy of HPV E6/E7 mRNA and TCT in cervical lesions.2.Analysis of the shunting effect of HPV E6/E7 mRNA detection in the diagnosis of NILM,ASC-US and ASC-H in TCT;3.The relationship between HPV E6/E7 mRNA expression and histomorphological changes.Results:1.The positive rate and diagnostic efficacy of HPV E6/E7 mRNA detection and TCT in different cervical lesionsThe positive rates of TCT were 29.9%,45.7%,61.0%,and 78.6%in the inflammation group,LSIL group,HSIL group,and cervical cancer group,respectively.Cervical cancer group>HSIL group>LSIL group>Inflammation group,Compared with inflammation group(P<0.05).The result of TCT and severity of the lesions was positively correlated,r_s=0.284(P<0.05);The positive rates of HPV E6/E7 mRNA detection were 52.8%,91.3%,94.0%,92.9%in the inflammation group,LSIL group,HSIL group,and cervical cancer group,respectively.HSIL group>Cervical cancer group>LSIL group>Inflammation group,Compared with inflammation group(P<0.05),HPV E6/E7 mRNA type 16 positive rate increased with the severity of cervical lesions(P<0.05);The result of TCT and severity of the lesions was positively correlated,r_s=0.459(P<0.05).The sensitivity of HPV E6/E7 mRNA detection(93.1%)is higher than TCT(58.1%)(P<0.05);the specificity of TCT(70.1%)is higher than HPV E6/E7 mRNA(47.2%)(P<0.05),and the Youden index of HPV E6/E7 mRNA(40.3%)is higher than TCT(28.3%);The Kappa value of HPV E6/E7 mRNA(0.413)is higher than TCT(0.280),(P<0.001);The Az value of HPV E6/E7mRNA(0.702)is higher than TCT(0.638)(P>0.05).2.Analysis of HPV E6/E7 mRNA expression in cases with NILM,ASC-US and ASC-H in TCTA total of 168 cases was diagnosed as of NILM in TCT,107 cases of HPV E6/E7mRNA were positive,and histopathological diagnosis of LSIL and above were 59 cases,accounting for 19.4%(59/304):including 22 cases of LSIL,accounting for 7.2%(22/304);35 cases of HSIL,accounting for 11.5%(35/304);2 cases of cervical cancer,accounting for 0.7%(2/304).61 cases of negative of HPV E6/E7 mRNA,including 53 cases of inflammation,accounting for 17.4%(53/304);3 cases of LSIL,accounting for 1.0% (3/304);4 cases of HSIL,accounting for 1.3%(4/304);1 case of cervical cancer;accounting for 0.3%(1/304).A total of 45 cases was diagnosed as of ASC-US in TCT,36 cases of HPV E6/E7 mRNA were positive,accounting for 11.8%(36/304),and 19 cases was diagnosed of LSIL and above in histopathological,accounting for 6.3%(19/304):including 6 cases of LSIL,accounting for 2.0%(6/304);10 cases of HSIL,accounting for 3.3%(10/304);3 cases of cervical cancer;accounting for 1.0%(3/304).9 cases of negative of HPV E6/E7 mRNA,all of them were diagnosed as inflammation,accounting for 3.0%(9/304).A total of 19 cases diagnosed as of ASC-H in TCT,17 cases of HPV E6/E7 mRNA was positive,accounting for 5.6%(17/304),and 15 cases was diagnosed of LSIL and above in histopathological,accounting for 4.9.%(15/304):including 3 cases of LSIL,accounting for 1.0%(3/304);10 cases of HSIL,accounting for 3.3%(10/304);2 cases of cervical cancer,accounting for 0.7%(2/304).2 cases of negative of HPV E6/E7 mRNA,all of them were diagnosed as inflammation in histopathology,accounting for 0.7%(2/304).3.Relationship between HPV E6/E7 mRNA expression and histomorphological changesA total of 76 cases were diagnosed inflammation in Histopathological and positive in HPV E6/E7 mRNA detection,11 cases with surface squamous epithelial mild hyperplasia,accounting for 14.5%(11/76),35 cases with glandular squamous,accounting for 46.1%.(35/76),and with the deeper and larger nuclear staining than the negative one,and the chromatin was slightly thicker.Of them,68 cases was negative in the HPV E6/E7 mRNA,3 cases with the surface squamous epithelial mild hyperplasia,accounting for 4.4% (3/68),13 cases with glandular squamous,accounting for 19.1%(13/68).It showed that the HPV E6/E7 mRNA positive cases were more obvious than the negative cases,although did not reach cervical intraepithelial lesions in histopathology.4.The positive rates of high-grade cervical lesions were 32.0%,33.7%,45.0%,31.9%,and42.8%,respectively,in the 19-29 years old group,the 30-39 years old group,the 40-49 years old group,the 50-59 years old group,and the group of 60 years old and above.40-49 years old group>60 years old and above group>30-39 years old group>19-29 years old group>50-59 years old group(P>0.05).Conclusion:1.The positive rates of HPV E6/E7 mRNA and TCT showed an increasing trend with the severity of cervical lesions,and both of them were positively correlated with the severity of cervical lesions.HPV E6/E7 mRNA detection positive rate,sensitivity,Youden index,and consistency with cervical lesions were higher than TCT,TCT specificity is higher than HPV E6/E7 mRNA.It is great significance for finding lesions timely,intervention of development of the cervical lesions and in clinical diagnosis that HPV E6/E7 mRNA detection.The subtype of HPV E6/E7 mRNA 16 is more advangtageous in screening high-grade cervical lesions.2.Combined with HPV E6/E7 mRNA detection can better manage the shunt of patients that in cases of NILM,ASC-US,or ASC-H in TCT,and the rate of missed diagnosis and misdiagnosis of cervical lesions can be reduced.3.More attention should pay on the cases that HPV E6/E7 mRNA positive though they were diagnosed as inflammation in histopathologically. |
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