ABSTRACT
Cytology triage has been generally recommended for human papillomavirus (HPV)-positive women, but is highly dependent on well-trained cytologists. The present study was designed to explore whether HPV E6/E7 mRNA detection in cervical exfoliated cells can be a potential triage for HPV-positive women from a clinic-based population. Both the primary HPV testing and Papanicolaou (Pap) test were performed on all eligible HPV-positive women. HPV E6/E7 mRNA was detected by QuantiVirus® HPV E6/E7 mRNA assay in cervical exfoliated cells. All HPV-positive women underwent colposcopy and further biopsy if indicated. The data were assessed by Pearson's Chi-squared test and the receiver operating characteristic curve. A total of 404 eligible HPV-positive women were enrolled. Positive rate of E6/E7 mRNA in high-grade squamous intraepithelial lesion (HSIL) cases was higher than that in low-grade squamous intraepithelial lesion (LSIL) or normal cases. There was no statistical difference found between mRNA and cytological testing with sensitivity (89.52% vs. 86.67%, P=0.671), specificity (48.96% vs. 48.96%, P=1.000), positive predictive value (39.00% vs. 38.24%, P=1.000), and negative predictive value (92.76% vs. 90.97%, P=0.678) for detecting ≥HSIL. HPV E6/E7 mRNA detection in cervical exfoliated cells shows the same performance as Pap triage for HSIL identification for HPV-positive women. Detection of HPV E6/E7 mRNA may be used as a new triage option for HPV-positive women.
Subject(s)
Oncogene Proteins, Viral/genetics , Papillomaviridae , Papillomavirus E7 Proteins/genetics , RNA, Viral/genetics , Uterine Cervical Neoplasms/diagnosis , Adult , Aged , Biopsy , DNA, Viral/genetics , Female , Humans , Middle Aged , Models, Statistical , Predictive Value of Tests , RNA, Messenger/genetics , RNA, Messenger/metabolism , ROC Curve , Sample Size , Sensitivity and Specificity , Uterine Cervical Neoplasms/virologyABSTRACT
OBJECTIVE: To evaluate clinical and pathologic factors associated with pelvic lymph node metastasis in patients with early-stage squamous cell carcinoma of the uterine cervix. METHODS: From February 2004 to January 2007, 135 patients with stage Ib-IIa cervical squamous cell carcinoma in Women's Hospital, School of Medicine, Zhejiang University, were retrospectively studied. The relationship between pelvic lymph node metastasis and age, clinical stage, tumor size, grade of differentiation, depth of muscular invasion, lymphatic vascular space invasion, pretreatment level of serum squamous cell carcinoma antigen, pretreatment plasma level of fibrinogen, pretreatment levels of hemoglobin and platelet were evaluated by univariate and multivariate analyses. RESULTS: Totally 3996 lymph nodes were dissected in 135 patients, with an average of 29.6 lymph nodes in each patient. 12.6% of the patients (17/135) had metastasized pelvic lymph nodes. Univariate analysis indicated that tumor size (P = 0.003), depth of muscular invasion (P = 0.004), vascular space invasion (P < 0.01), pretreatment levels of platelet (P = 0.006) and fibrinogen (P < 0.01) were significantly related to pelvic lymph node metastasis. Multivariate logistic regression analysis showed that lymphatic vascular space invasion (OR: 3.674, 95% CI: 1.825 - 7.393, P < 0.01) and pretreatment plasma level of fibrinogen (OR: 4.568, 95% CI: 1.779 - 11.725, P = 0.002) were significantly related to pelvic lymph node metastasis in patients with early-stage squamous cell carcinoma of the uterine cervix. CONCLUSION: In early-stage cervical squamous cell carcinoma, lymphatic vascular space invasion and higher pretreatment plasma levels of fibrinogen are risk factors of pelvic lymph node metastasis.
