Study On The Value Of High-risk HPV Viral Load Combined With Colposcopy In Evaluating Cervical High-grade Squamous Intraepithelial Lesion

Objectives:1.To investigate the correlation between viral load of high-risk human papillomavirus(HPV)and the accuracy of colposcopy screening for HSIL.2.In colposcopy,can the quantitative detection results of hr-HPV be used to improve the detection rate of HSIL,And infer whether there is a diagnostic threshold for hr-HPV viral loads that can distinguish HSIL from low-grade squamous intraepithelial lesion(LSIL)and below;When the colposcopy results are insufficient or unsatisfactory,the threshold range can be regarded as a warning to suspicious HSIL cases.Methods:A total of 134 patients who are not mixed infection of HPV16/18 and other 12 types of HPV,were enrolled from 159 patients who underwent cervical cancer screening and HPV viral load,and final hr-HPV positive cases were diagnosed as HSIL+ by cervical biopsy or curettage in our hospital from August 2017 to May 2019.We used DH3 to detect 14 types of hr-HPV viral loads by using Human papillomavirus(HPV)nucleic acid detection kit,and the result criterion is that viral load>1pg/m L was positive.According to the types of HPV,the subjects were divided into 71 cases of HPV16/18 positive group and 63 cases of other 12 high-risk HPV positive group.In HPV16/18 positive group,4 cases of normal colposcopic finding(NCF),34 cases of LSIL and 33 cases of HSIL.In other 12 high-risk HPV positive group,37 cases of LSIL and 26 cases of HSIL.The relationship between hr-HPV viral loads and colposcopy results was analyzed by Spearman test.The receiver operating characteristic(ROC)curve was used to find the diagnostic threshold which can effectively predict HSIL diagnosed by colposcopy.Results:1.HPV16/18:(1)With the increase of accuracy of HSIL detection by colposcopy,the viral load of HPV16/18 also increased(rs=0.545,P<0.001).(2)Under colposcopy screening alone,the sensitivity of cervical HSIL was 46.5%,the rate of missed diagnosis was 53.5%.When the virus load value of 113.56pg/m L was taken as the threshold,the sensitivity of cervical HSIL was 52.1%,and the rate of missed diagnosis was 47.9%,the rate of missed diagnosis was 5.6% lower than before.Viral load combined with colposcopy screening can reduce the rate of missed diagnosis of cervical HSIL rather than colposcopy screening alone,and the effect is better than that of colposcopy screening alone(P < 0.001).2.Other 12 high-risk HPV:(1)There was no correlation between the viral load of the other 12 high-risk types of HPV and the accuracy of HSIL detection by colposcopy(rs=0.078,P=0.543).(2)The viral loads of other 12 high-risk HPV types have no predictive value in the detection rate of HSIL by colposcopy.Conclusions:The higher the viral load of HPV16/18 type,the higher the accuracy of cervical HSIL diagnosis under colposcopy.When the threshold of viral load was 113.56pg/m L,the viral load combined with colposcopy screening can reduce the rate of missed diagnosis of cervical HSIL rather than colposcopy screening alone,the combination of viral load and colposcopy diagnosis could provide a risk indication for the accuracy of cervical HSIL.