The Application Value Of High-risk HPV Subtype?HPV E6/E7mRNA Detection And DNA Ploidy Analysis In Early Cervical Cancer Screening

Objective:Retrospective analysis included age distribution,cervical general condition,marital and childbearing history,pregnancy and birth history,screening methods,screening results and histopathological results.To explore the clinical value of hr-hpv subtype detection,HPV E6/E7mRNA detection and DNA ploidy analysis in early cervical screening and risk assessment,and to find the optimal and most economical screening method.Methods:From June 2017 to December 2018,We collected patient date from the outpatient department of gynaecology of binzhou medical college.Selecting 516 patients with four results at the same time:hr-hpv subtype detection,HPV E6/E7mRNA detection,DNA ploidy analysis and cervical histopathological examination.By analyzing the types and distribution of high-risk HPV infection in the included patients,the relationship between high-risk HPV infection and cervical lesions was determined,To explore the association between single and multiple high-risk HPV infections and cervical lesion development,and the impact of hpv16/18 infection on cervical lesion development;To calculate the positive rate of three tests in different pathologies,to analyze the differences between different methods in each group;We calculated sensitivity,specific,positive predictive value,negative predictive value,some index and coincidence rate of HPV subtype detection,HPV E6/E7mRNA,DNA ploidy analysis respectively in screening cervical HSIL+lesions.To compare used alone the three detection methods for cervical HSIL+lesions diagnostic performance;We calculated the sensitivity,specificity,positive predictive value and negative predictive value of HPV E6/E7mRNA detection and DNA ploidy analysis for screening cervical HSIL+lesions in patients with high-risk HPV infection,and drew the ROC curve of the two to compare their shunt value for patients with high-risk HPV infection;Draw the ROC curve of the diagnostic value of rh-hpv substype detection,HPV E6/E7mRNA detection and DNA ploidy analysis for cervical HSIL+lesions,compare the area under each curve,and analyze the clinical value of rh-hpv subtype detection,HPV E6/E7mRNA detection and DNA ploidy analysis in the diagnosis of cervical HSIL+lesions.Results:1.516 patients included 340 cases of cervical inflammation,55 cases of LSIL,101 cases of HSIL,and 20 cases of cervical cancer,ranging from 21 to 65 years old.Patients with contact bleeding significantly increased in the cervical HSIL group and cervical cancer group.The cervical cancer group had the lowest average age of first marriage(19.7years).2.Among the patients included in the study,the top five high-risk HPV infection rates were hpv-16,hpv-58,hpv-18,hpv-52 and hpv-33.The infection rate of high-risk HPV in cervical HSIL group and cervical cancer group increased significantly.Hpv16/18 infection was more carcinogenic than other types of HPV infection(P<0.05).There was no significant difference in carcinogenicity between single infection and multiple infection(P>0.05).3.The positive rate and copy number of HPV E6/E7mRNA in patients with different pathological grades of cervical lesions were statistically different(P<0.05),and the copy number increased with the pathological grade(r=0.582,P<0.05).Similarly,the positive rate of DNA ploidy analysis results and the number of diseased cells were also statistically different in different pathological levels(P<0.05),and the number of diseased cells was significantly increased with the increase of pathological level(r=0.414,P<0.05).4.In the diagnosis of cervical HSIL+lesions,the sensitivity(94.2%)and negative predictive value(96.3%)of rh-hpv subtype detection were the highest,and the specificity(77.2%),positive predictive value(48.6%),yoden index(0.474)and accuracy(75.5%)of DNA ploidy analysis were the highest.5.Comparing rh-hpv typing test with HPV E6/E7mRNA,the specificity of rh-hpv typing was lower than that of HPV E6/E7mRNA,and the difference was statistically significant(P<0.05),while the sensitivity,positive predictive value and negative predictive value were all higher than HPV E6/E7mRNA,but there was no statistically significant difference(P>0.05).Comparing rh-hpv typing test with DNA ploidy analysis,hr-hpv typing has higher sensitivity and statistical difference(P<0.05),which is more significant for the detection of diseases and more suitable for screening,while DNA ploidy analysis has higher specificity and significant difference(P<0.05),which is more significant.for the exclusion of diseases;The sensitivity of HPV E6/E7mRNA was higher than that of DNA ploidy analysis,and the difference was statistically significant(P<0.05).6.In patients with high-risk HPV infection screening cervical HSIL+lesions,HPV E6/E7mRNA detection sensitivity,specific degree,positive predictive value,negative predictive value,and the area under the ROC curve were higher than the DNA ploidy analysis,and the sensitivity of the differences between statistically significant(P<0.05),the diagnostic efficiency higher than DNA ploidy analysis.7.Hr-hpv subtype detection,HPV E6/E7mRNA detection and DNA ploidy analysis were all significant in the diagnosis of cervical HSIL+lesions.The area under the ROC curve of the three was 0.671,0.819 and 0.759,respectively.The ROC-AUC of HPV E6/E7mRNA was greater than 0.8,indicating the high value of HPV E6/E7mRNA alone in the diagnosis of cervical HSIL+lesions.In the combined screening,the area under the ROC curve detected by the three methods was the largest(roc-auc=0.853),indicating that the combined use of the three methods had the highest diagnostic value for cervical HSIL+lesions.Conclusions:1.The occurrence and development of cervical cancer is closely related to high-risk HPV infection,among which the carcinogenicity of hpv16/18 infection is stronger than that of other high-risk HPV infection,but there is no significant difference in the carcinogenicity between single infection and multiple infection of high-risk HPV.2.With the increase of cervical pathology level,the positive detection rate of HPV E6/E7mRNA and DNA ploidy analysis was also gradually increased,and the higher the copy value of HPV E6/E7mRNA and the number of diseased cells found in DNA ploidy analysis,the greater the risk of cervical cancer.3.HR-HPV testing is cervical cancer screening method with high sensitivity in cervical HSIL+lesion screening,but its specificity is low,the overall diagnostic value is lower than the HPV E6/E7mRNA and DNA analysis.4.The efficacy of HPV E6/E7mRNA detection in shunt management of patients with high-risk HPV infection is higher than that of DNA ploidy analysis,which effectively improves the diagnostic efficiency and avoids excessive treatment.5.From two aspects of economic cost effective diagnosis and screening efficiency analysis together,it is recommended to use HPV E6/E7mRNA times analysis of DNA screening HSIL and above of cervical lesions.