| Objective To evaluate the value of the human papilloma virus(HPV)oncogene E6/E7 m RNA examination in hierarchical management of patients with non-16 and 18high-risk HPV infection and atypical squamous cell of negative for intraepithelial lesion or malign(NILM).Methods Retrospective analysis was performed on the data of 383 patients with non16 and 18 high-risk HPV infection and atypical squamous cells of NILM in The First Affiliated Hospital of Bengbu Medical College from October 2020 to October 2021.The results of the HPV DNA typing test,HPV E6/E7 m RNA test and the histopathological results of cervical biopsy were statistically analyzed.Analysis of HPV E6/E7 m RNA detection results and copy number in cervical lesions of different grades.Explore the value of HPV E6/E7 m RNA detection for hierarchical management of patients with non-16/18 high-risk HPV infection and NILM as TCT results.Results 1.In 383 patients with non-16/18 high-risk HPV infection and TCT NILM,all 12 high-risk HPV types were detected,the total positive number of non-16/18 types HPV was 474(multiple infections counted repeatedly),and the top 7 HR-HPV genotypes were: HPV52(24.47%),HPV58(15.82%),HPV53(11.81%),HPV51(8.44%)and HPV56(8.44%),HPV33(6.33%),HPV39(5.70%).Single-type virus infection were 303 cases(79.11%),mixed infection with 2 types of HPV infection were 71 cases(18.54%),mixed infection with 3 types HPV were 7 cases(1.83%),and mixed infection with 4 types were 2 cases(0.52%).2.The top five non-16/18 high-risk HPV infections in the LSIL group were HPV52,58,56,51,53 and the HSIL+ group were HPV58,52,31,35,33.3.According to the pathological results of colposcopy cervical biopsy,383 patients were divided into 252 cases of chronic cervical inflammation(65.80%),98 cases of low-grade squamous intraepithelial lesion(LSIL)(25.59%),and 33 cases of high-grade squamous intraepithelial lesion and above(8.62%).The positive detection rates of HPV E6/E7 m RNA in chronic cervical inflammation,LSIL and HSIL+groups were 40.48%,64.29% and 66.67%,respectively.The difference was statistically significant(P<0.001).4.The expression of HPV E6/E7 m RNA in NILM,LSIL and HSIL+ groups were0.000(0.000,1139.463)copies/m L,811.772(0.000,4017.910)copies/m L and1002.969(0.000,5146.578)copies/m L,respectively.The difference among the three groups was statistically significant(P<0.001).There was a positive correlation between the pathological grade of cervical lesions and the expression of HPV E6/E7 m RNA(r=0.254,P<0.05).5.The area under the ROC curve(AUC value)for detecting LSIL and above lesions by HPV E6/E7 m RNA was 0.644.CUTOFF>484.915copy/ml was used as criteria,the sensitivity and specificity were 61.8% and 64.7%,respectively,and the Youden index was 0.265.HPV E6/E7 m RNA positive(≥ 1copy/m L)was used as criteria for detecting LSIL and above lesions,the sensitivity and specificity were 64.8% and59.5%,respectively,and the Youden index was 0.243.The area under the ROC curve(AUC value)for detecting HSIL and above lesions by HPV E6/E7 m RNA was 0.623.CUTOFF>741.092 copy/ml,the sensitivity and specificity were 63.6% and 64.3%,respectively,and the Youden index was 0.279.HPV E6/E7 m RNA positive(≥1copy/m L)was used as criteria for detecting HSIL and above lesions,the sensitivity and specificity were 66.7% and 52.9%,respectively,and the Youden index was 0.196.Conclusion 1.The top 7 non-16/18 HR-HPV genotypes of our hospital were HPV52,HPV 58,HPV 53,HPV 51,HPV 56,HPV 33 and HPV 39.2.The HR-HPV types in different levels of cervical lesions in patients with high-risk HPV non16 and 18 infection and atypical squamous cells of NILM were slightly different.Patients in HSIL and above lesion the infection rates of HPV types 58,52,31,35,and 33 are high they should be regarded as high-risk groups,and should be managed in a stratified manner.3.The positive rate of HPV E6/E7 m RNA increases with the increase of cervical lesion level.The number of viral m RNA copies(copy/ml)in patients with various levels of cervical lesions.As the lesion level increases,the COPY value also increases.The level of expression and activity are positively correlated with the severity of cervical lesions.Potential high-level lesions can be detected as early as possible,while low-risk lesions can be excluded.4.The HPV E6/E7 m RNA test has high specificity and sensitivity in patients with high-risk HPV non-16 and 18 infection and TCT NILM.Using the HPV E6/E7 m RNA copy number >741.092copies/m L as criteria has higher specificity than using HPV E6/E7 m RNA positive(copy number ≥1 copies/m L)as criteria for detecting HSIL and above lesions.Using the HPV E6/E7 m RNA copy number<484.915copies/m L as criteria has higher specificity than using HPV E6/E7 m RNA positive(copy number ≥1 copies/m L)as criteria for detecting LSIL and above lesions.Patients with high-risk HPV non-16 and 18 infection and TCT NILM combined HPV E6/E7 m RNA test copy number >741.092 copies/m L be referred for colposcopy,and patients with a copy number <484.915 copies/m L be advised to review one year later according to current guidelines.This can effectively divert patients,reduce the colposcopy referral rate and reduce the missed diagnosis rate. |
PDF Full Text Request