The Application Value Of HPV DNA,HPV E6/E7mRNA Detection And TCT Examination In Cervical Cancer Screening

Background:Cervical cancer is the fourth most common female malignancy in the world.There are approximately 530,000 new cases each year in the world,and approximately 270,000 people die.About 85%of these deaths occur in underdeveloped or developing countries.At present,cervical cancer screening strategies are not the same.Cervical cancer prevention and control are still the focus and difficulty in domestic medicine.Objective:This study explored the value of three common screening methods for cervical cancer in cervical cancer screening and compared them,hoping to provide a basis for the selection of cervical cancer screening strategies.Methods:324 patients with cervical lesions who had undergone HPV DNA detection,E6/E7mRNA detection,TCT examination,and histopathological examination at the Binzhou Medical University Hospital from June 2016 to November 2017 were selected as the study population.Pathological examination included cervical biopsy,cervical LEEP and cold-cold conization.Preoperative colposcopy was performed to guide the scope of surgery.If the same patient had two or more operations at the same time and the postoperative pathological results were inconsistent,the result with high histopathological grade was the statistical standard.Using the pathological results of CIN Ⅱ+ as the screening target,the sensitivity,specificity,positive predictive value,negative predictive value of HPV DNA detection,HPV E6/E7 mRNA detection,and TCT examination in screening were calculated.Evaluate the application value of the three methods in screening and compare with each other.The positive rates of HPV DNA and HPV E6/E7 mRNA in cervical lesions at each level were compared.The differences in the positive rates between the two groups in cervical lesions were analyzed,and the consistency of the positive rate between them was analyzed.CINII+ was used as a screening target to calculate the sensitivity,specificity,positive predictive value,and negative predictive value of HPV E6/E7 mRNA detection and TCT examination in HPV DNA positive cases.Select a better shunting effect when HPV DNA is positive.The positive rates of HPV E6/E7 mRNA detection in the most common single HPV subtypes of the study population were analyzed,and the carcinogenicity of different HPV subtypes was compared.Statistical data and analysis of count data were analyzed using SPSS 17.0 software.Differences in screening methods for different test methods were analyzed using the x2 test.P<0.05 was considered statistically significant.The consistency of the positive rate in the cervical lesions at each level was compared using the k values of HPV DNA and HPV E6/E7 mRNA.Results:1.Using CIN Ⅱ+ as a screening target,the sensitivity,specificity,positive predictive value,and negative predictive value of HPV E6/E7 mRNA detection were 91.2%,77.6%,89.2%,and 81.4%,respectively.HPV DNA detection was 94.9%,62.6%,83.7%,and 85.9%,respectively.TCT examination were 87.6%,64.5%,83.3%,and 71.9%,respectively.The specificity of detection of HPV E6/E7 mRNA was higher than that of HPV DNA,and the difference was statisticallysignificant(x =5.707,P<0.05).There was no significant difference in sensitivity,positive predictive value and negative predictive value(P>0.05).HPV DNA detection sensitivity and negative predictive value were higher than TCT,the difference was statistically significant(X2=6.725,P<0.05;X2=4.957,P<0.05),but there was no significant difference in specificity and positive predictive value(P>0.05).2.In the normal and inflammatory groups,the positive rate of HPV DNA detection was significantly higher than HPV E6/E7 mRNA detection,and the difference was statistically significant(X2=9.353,P=0.002).The statistical analysis index k value of the two detection methods was 0.286,indicating that the consistency of the two methods was poor.In the CIN Ⅰ,CIN Ⅱ-Ⅲ,and cervical cancer groups,there was no significant difference in the positive rate of HPV DNA detection and HPV E6/E7 mRNA detection(P>0.05).In the three groups,the consistency of the two methods was better(k>0.75).From the value of k,it can be seen that the consistency of the two detection methods increases with the level of cervical lesions.3.HPV E6/E7mRNA detection and TCT examination were used for the shunting of HPV DNA positive cases.With CIN Ⅱ+ as the screening target,HPV E6/E7 mRNA detection sensitivity(94.2%)was higher than TCT examination(86.4%),and the difference was statistically significant(X2＝76.831,P<0.05).The specificity,positive predictive value and negative predictive value were not significantly different from TCT examination(P>0.05).4.The most common four single high-risk HPV subtype infections in the study population from the highest to the lowest positive rate were:HPV 16,33,18,and 58 subtypes,corresponding to HPV E6/E7 mRNA detection rate was 77.8%,42.3%,66.6%,and 41.2%,respectively.Conclusions:1.With CIN Ⅱ + as the screening target,three cervical cancer detection methods were overall evaluated.E6/E7 mRNA detection was superior to HPV DNA detection,and HPV DNA detection was superior to TCT.If clinically only a single test method is used for cervical cancer screening,E6/E7 mRNA detection may be selected.2.Compared with HPV DNA detection,E6/E7 mRNA detection has similar sensitivity to the diagnosis of cervical intraepithelial neoplasia and cervical cancer,but it has an advantage in the diagnosis of normal and inflammatory groups.It can reduce the transient HPV.The false positive rate caused by virus infection.3.When HPV DNA was used for primary screening of cervical cancer,CINⅡ+ was used as the screening target,and E6/E7 mRNA detection was better than TCT examination.4.The positive rate of E6/E7 mRNA was higher in patients with HPV 16 and 18 subtype infections,confirming that the HPV 16 and 18 subtypes have higher carcinogenicity.