HPV E6/E7 mRNA联合细胞学检查用于子宫颈癌早期筛查的初步评价

Preliminary evaluation of HPV E6/E7 mRNA and cytology test for early screening of cervical cancer

目的探讨人乳头瘤病毒(HPV)E6/E7 mRNA联合液基薄层细胞学检查(TCT)用于宫颈癌早期筛查的初步评价。方法收集2015年10月—2019年7月在本院进行宫颈癌筛查患者825例,均进行HPV E6/E7 mRNA、TCT检测,以组织病理学为金标准,分析HPV E6/E7 mRNA与TCT联合检测用于评估患者宫颈病变风险的诊断效能。结果HPV E6/E7 mRNA检测和TCT检测不同病理分级患者宫颈慢性炎、低级别鳞状上皮内病变(LSIL)、高级别鳞状上皮内病变(HSIL)、宫颈癌的阳性率分别为12.17%、39.04%、86.61%、87.88%和36.51%、82.89%、82.14%、81.82%。HPV E6/E7 mRNA检测的敏感性为86.90%,特异性为80.44%,准确性为81.58%。TCT检测的敏感性为82.07%,特异性为50.74%,准确性为56.24%。HPV E6/E7 mRNA联合TCT检测的敏感性为70.34%,特异性为83.68%,准确性为81.33%。HPV E6/E7 mRNA与TCT联合检测特异性高于单一检测,差异有统计学意义(P<0.001)。HPV E6/E7 mRNA与TCT两种检测方法的受试者工作特征曲线(ROC)曲线下面积(AUC)分别为0.837和0.664,两者联合检测的AUC为0.860,差异性显著(P<0.001),提示联合诊断可提高诊断宫颈HSIL的性能。结论HPV E6/E7 mRNA联合TCT能够更好预测宫颈病变的进展,且针对高级别病变的筛查具有更高的特异性,可为临床宫颈癌筛查提供参考。

Objective To explore the preliminary evaluation of HPV E6/E7 mRNA combined with cytology for early screening of cervical cancer.Methods A total of 825 patients who underwent cervical cancer screening in our hospital from October 2015 to July 2019 were collected.HPV E6/E7 mRNA and TCT were detected,and the diagnostic efficacy was analyzed using histopathology as the standard to evaluate the risk of cervical lesions in patients.Results The positive rates of cervical chronic inflammation,low grade squamous intraepithelial lesion(LSIL),high grade squamous intraepithelial lesion(HSIL)and cervical cancer detected by HPV E6/E7 mRNA and TCT were 12.17%,39.04%,86.61%,87.88%and 36.51%,82.89%,82.14%and 81.82%,respectively.The sensitivity,specificity and accuracy of HPV E6/E7 mRNA detection were 86.90%,80.44%and 81.58%respectively.The sensitivity,specificity and accuracy of TCT were 82.07%,50.74%and 56.24%respectively.The sensitivity,specificity and accuracy of HPV E6/E7 mRNA combined with TCT were 70.34%,83.68%and 81.33%,respectively.The specificity of HPV E6/E7mRNA combined with TCT was higher than that of single detection,and the difference was statistically significant(P<0.001).The area under ROC curve of HPV E6/E7 mRNA and TCT were 0.837 and 0.664,respectively,and the area under ROC curve of the combined detection of HPV E6/E7 mRNA and TCT was 0.860,and the difference was statistically significant(P<0.001),which suggesting that the combined diagnosis can improve the performance of the diagnosis of cervical HSIL+.Conclusion HPV E6/E7 mRNA combined with TCT can better predict the progression of cervical lesions,and has higher specificity for high-grade cervical lesions,and can provide reference for clinical cervical cancer screening.