| Objective:High-risk HPV E6/E7 mRNA and DNA testing are very important for cervical cancer screening.At present,there have been many studies to evaluate it.This study systematically evaluated the clinical value and accuracy of high-risk HPV E6 / E7 mRNA and DNA testing in the diagnosing of high-grade cervical lesions with the methods of meta analysis,in order to obtain more accurate conclusions to provide possible evidence based medical evidence for clinical work.Methods:We fully searched English databases such as PubMed,Web of Science,Cochrane Library,Medline,Embase,and Chinese databases such as China Knowledge Network(CNKI),Wanfang Database,and Chinese Biomedical Literature Database(CBM)from building of these database to January 2020.We selected relevant clinical studies on the screening of cervical cancer using high-risk HPV E6 / E7 mRNA and DNA testing at the same time,and screened them according to the inclusive and exclusive criteria.The cervical tissue biopsy was used as the gold standard to investigate the sensitivity and specificity of high-risk HPV E6 / E7 mRNA and DNA testing for high-grade cervical lesions diagnosing.The quality of the included studies was evaluated by using the QUADAS tool in the Review Manager 5.3 software.Statistical analysis was performed on the original data using STATA 15.1 software and subgroup analysis was performed to determine the source of heterogeneity.Results:The search was performed according to the literature search strategy and the literature was screened according to the PRISMA statement.A total of 18 studies were included,including 12 in English and 6 in Chinese,including 9229 participants.(1)The clinical sensitivity(Sen)of HPV E6 / E7 mRNA detection for high grade cervical lesions and cervical cancer(CIN(47)+)diagnosis was 0.90,and its 95%confidence interval was(95% CI: 0.87-0.92);Specificity(Spe)was 0.70,and its 95%confidence interval was(95% CI: 0.62-0.78);The area under curve(AUC)of the systematic receiver operating curve(SROC)was 0.91,and its 95% confidence interval was(95% CI: 0.88-0.93).(2)The HPV DNA testing for CIN(47)+ diagnosis had a Sen of 0.93(95% CI:0.91-0.95);a Spe of 0.46(95% CI: 0.33-0.60);an AUC of SROC of 0.91,(95%CI: 0.89-0.94).(3)When HPV E6 / E7 mRNA detection was used to diagnose CIN(47)+,the comparison of the total sample(n≥300 cases)group with the(n <300 cases)group showed that(Sen = 0.90)VS(Sen = 0.90);(Spe = 0.68)VS(Spe = 0.74);(+LR = 2.8)VS(+ LR = 3.5);(-LR = 0.15)VS(-LR = 0.13);(DOR = 19)VS(DOR = 27);(AUC = 0.90)VS(AUC = 0.92).(4)When HPV DNA testing was used to diagnose CIN(47)+,the comparison of the total sample(n≥300 cases)group with the(n <300 cases)group showed that(Sen= 0.93)VS(Sen = 0.93);(Spe = 0.47)VS(Spe = 0.46);(+ LR = 1.7)VS(+LR = 1.7);(-LR = 0.15)VS(-LR = 0.15);(DOR = 12)VS(DOR = 12);(AUC= 0.91)VS(AUC = 0.92).Conclusions:In the diagnosis of CIN(47)+,the clinical sensitivity and diagnostic efficacy of HPV E6/E7 mRNA testing and HPV DNA testing ware comparable,but the specificity of the former is significantly better than HPV DNA testing.Therefore,HPV E6/E7 mRNA detection is of great significance for cervical cancer screening,and may be a better screening method than HPV DNA detection.When HPV E6 / E7 mRNA detection and HPV DNA detection were used to diagnose CIN(47)+,a large sample size(n≥300 cases)and a small sample size(n<300 cases)were compared and analyzed,there were no significant differences in the Sen,Spe,+ LR,-LR,DOR and AUC,but the results still showed that the specificity of HPV E6 / E7 mRNA detection for CIN(47)+ was significantly higher than that of HPV DNA detection. |
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