| Objective: By comparing and analyzing HPV E6/E7 mRNA,HPV DNA,P16,TCT and Ki67,the best screening method with the highest diagnostic efficiency and the best health economics was selected,in order to reduce the invasive operation rate and improve the diagnosis rate of high-grade cervical squamous intraepithelial lesions,so as to provide basis for clinical diagnosis and treatment.Methods: A retrospective study was conducted on women who were diagnosed and treated for cervical diseases(including chronic cervicitis,cervical squamous intraepithelial lesion and cervical cancer)in the Affiliated Hospital of Guilin Medical College from October 2018 to October 2020.The inclusion and exclusion criteria were strictly followed,finally,202 subjects were selected(16of them were lack of TCT results(TCT was not performed because most of the patients with cervical cancer had reached clinical diagnosis),and the other 186 subjects had complete data).A total of 43 subjects of pathological tissue paraffin specimens from 186 subjects were selected by stratified random sampling for Ki67 immunohistochemical detection.Based on the histopathological results,the differences of five detection methods of HPV E6/E7 mRNA,HPV DNA,P16,TCT and Ki67 in chronic cervicitis and cervical lesions were analyzed,and the sensitivity,specificity,coincidence rate,positive predictive value,negative predictive value,kappa consistency test and the area under ROC curve of HPV E6/E7 mRNA,HPV DNA,P16,TCT and Ki67 were calculated,select the best screening method for CIN2+ diagnostic efficacy and health economics.Results:(1)There were significant differences in the detection methods of HPV E6/E7 mRNA,HPV DNA,P16,TCT and Ki67 in chronic cervicitis and cervical lesions.With the increase of pathological grade,the positive rate showed an upward trend.HPV E6/E7 mRNA related light unit(S/CO)in cervicitis,cervical lesions at various levels,there was no statistically significant difference.(2)When TCT results are ASCUS and ASC-H,it has no significant shunting effect on CIN2+.(3)HPV E6/E7 mRNA,HPV DNA,p16,TCT and Ki67 were used to detect and diagnose CIN2+ separately,the highest detection efficiency was P16(AUC = 0.820,kappa = 0.667),followed by Ki67(AUC=0.644,kappa=0.292),and the lowest detection efficiency was TCT(AUC=0.565,kappa= 0.139).(4)HPV E6/E7 mRNA,HPV DNA,p16,TCT and Ki67 detection methods were used in series to diagnose CIN2+.The highest diagnostic efficiency was HPV DNA tandem p16(AUC = 0.822,kappa = 0.668),followed by TCT tandem p16(AUC= 0.813,kappa = 0.635).The lowest diagnostic efficiency was HPV E6/E7 mRNA tandem TCT(AUC=0.608,kappa= 0.220).(5)The detection methods of HPV E6/E7 mRNA,HPV DNA,p16,TCT and Ki67 were combined in parallel to diagnose CIN2+,the highest diagnostic efficiency was Ki67 parallel p16(AUC =0.667,kappa = 0.338),followed by HPV E6/E7 mRNA parallel p16(AUC=0.627,kappa=0.285).The lowest diagnostic efficiency was HPV E6 / E7 mRNA parallel HPV DNA parallel TCT(AUC=0.524,kappa=0.053).(6)Detection methods of HPV E6 / E7 mRNA,HPV DNA,p16,TCT and Ki67 were detected separately and jointly(parallel and Series)to diagnose CIN2+,the highest detection efficiency was HPV DNA series p16(AUC = 0.822,kappa = 0.668),followed by p16(AUC = 0.820,kappa = 0.667).The worst diagnostic efficiency was HPV E6/E7 mRNA parallel HPV DNA parallel TCT(AUC=0.524,kappa=0.053).Conclusions:(1)The differences of HPV E6/E7 mRNA,HPV DNA,p16,TCT and Ki67 in chronic cervicitis and cervical lesions are statistically significant.With the increase of pathological grade,the positive rate shows an upward trend.(2)Detection methods of HPV E6/E7 mRNA,HPV DNA,p16,TCT and Ki67 are detected separately and jointly(parallel and Series)to diagnose CIN2+,the highest detection efficiency is HPV DNA series p16(AUC = 0.822,kappa =0.668),followed by p16(AUC = 0.820,kappa = 0.667).The worst diagnostic efficiency is HPV E6/E7 mRNA parallel HPV DNA parallel TCT(AUC=0.524,kappa=0.053).(3)The value of HPV E6/E7 mRNA related light unit(S/ CO)cannot be used to judge the severity of cervical lesions. |
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