| Objective To investigate the application value of single or combined detection of Aptima HPV E6/E7 mRNA(Aptima HPV)and thinpre cytological test(TCT)in clinical screening of cervical lesions and cervical cancer,and the application value of Aptima HPV genotyping in risk stratification of patients with atypical squamous cells(ASC)and low-grade squamous intraepithelial lesions(LSIL).Methods Patients who underwent cervical biopsy in Tangshan Maternal and Child Health Care Hospital from October 1,2018 to October 30,2019 were selected as the study subjects,and the results of Aptima HPV and TCT in patients were collected.A total of 901 patients with complete data were included.To analyze the distribution of human papillomavirus(HPV)infection and cervical lesions and their relationship with age.Taking the histopathological results as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,youdan index,Kappa value,odds ratio(OR)and area under the receiver operating characteristic curve(ROC)of the two methods were calculated.Results 1 The positive rate of HPV in age group of 39-39 years was the highest(86.5%),the second is the group of ≤29 years(82.9%),but the detection rate of cervical cancer was lower(0.7%,0%),the detection rate of high-grade cervical squamous intraepithelial lesion(HSIL)and cervical cancer increased with age,and the difference was statistically significant.2 With the increase of cytological grade,the positive rate of HPV increased significantly(42.9%,82.2%,82.7%,100%).With the increase of histopathological grade,the positive rate of HPV increased significantly(17.1%,85.9%,92.4%,100%).The positive rate of HPV 16 was the highest in cervical cancer group(61.5%),and the difference was statistically significant(P<0.001).3 The risk of highgrade squamous intraepithelial lesion or worse(≥HSIL)in Aptima HPV positive was7.506 times higher than that of negative(95%CI: 4.096-13.758),and the difference was statistically significant(P<0.001).The risk of cervical lesions ≥HSIL in TCT positive was 3.133 times higher than negative(95%CI: 2.057-4.773),and the difference was statistically significant(P<0.001).The detection rate of high-grade cervical lesions and cancer was the highest in the group with simultaneous positive of HPV 16/18/45.Compared with Aptima HPV negative,the risk of cervical lesions ≥HSIL with HPV16/18/45 positive was the highest,which increased by 22 times,followed by HPV 16 positive,and the risk increased by about 19.8 times,which was significantly higher than that of HPV18/45 positive and other types positive,the difference was statistically significant(P<0.001).4 The area under the ROC curve(AUC)of Aptima HPV,TCT and combined test for the diagnosis of cervical lesions ≥HSIL were 0.646(95%CI: 0.605-0.686),0.612(95%CI: 0.568-0.656)and 0.670(95%CI: 0.632-0.709),respectively.The accuracy of combined diagnosis was the highest.The sensitivity(92.98%),positive predictive value(25.44%)and negative predictive value(95.56%)of Aptima HPV for≥HSIL were higher than that of TCT test(82.46%,24.35%,90.68%),and the specificity was lower than that of TCT test(36.16% vs 40.00%).The sensitivity(98.83%)and negative predictive value(98.91%)of the combined detection of the two methods were the highest.5 The positive rates of HPV in women with ASC and LSIL were 82.2% and82.7%,respectively.Among the patients with ASC,according to pathological grade,28cases(9.6%)were normal/chronic inflammation,203 cases(69.5%)had LSIL,57 cases(19.5%)had HSIL,and 4 cases(1.4%)had cervical cancer.Compared with the Aptima HPV negative,the detection rate and risk of HPV 16 positive for ≥HSIL were the highest(OR=10.301,95%CI: 3.635-29.243),the differences were statistically significant(P<0.001).Among the patients with LSIL,according to pathological grade,12 cases(5.2%)were normal/chronic inflammation,184 cases(79.7%)had LSIL,35 cases(15.1%)had HSIL,and no cases of cervical cancer were detected.The detection rate and risk of HPV 16 positive for ≥HSIL were the highest(OR=3.267,95%CI: 0.893-11.952),but the difference was not statistically significant(P=0.605).Conclusion 1 Among the patients with cervical lesions,the positive rate of high-risk HPV was the highest in women aged 30-39 years,and the detection rate of cervical cancer is the highest in elderly women.2 The positive rate of Aptima HPV increased with the increase of the severity of cervical lesions.3 In the clinical screening of cervical lesions,the sensitivity,positive predictive value and accuracy of Aptima HPV were higher than those of TCT.Combined detection can improve the sensitivity,and effectively reduce the rate of missed diagnosis.4 Aptima HPV genotyping can be used for risk stratification of cervical lesions.Patients with Aptima HPV 16/18/45 positive,HPV 16 positive and women with ASC and HPV 16 positive are at high risk of highgrade cervical lesions and cervical cancer,which should be further examined and treated actively.Figure 8;Table 12;Reference 130... |
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