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Zhou SG, Wu DF, Yao H, Zhang WY, Tian FJ, Chen G, Zhang CF. REBACIN ® inhibits E6/E7 oncogenes in clearance of human papillomavirus infection. Front Oncol 2022; 12:1047222. [PMID: 36561517 PMCID: PMC9763439 DOI: 10.3389/fonc.2022.1047222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Previous studies have demonstrated that REBACIN® intervention eliminates persistent high-risk human papillomavirus (hrHPV) infection. The initial establishment and subsequent progression of cervical cancer mainly depends on two major oncogenes, E6/E7, and previous studies have proposed E6/E7 oncogenes as a target for therapeutic drug development. The aim of this study was to investigate in vitro and in vivo whether REBACIN® inhibits E6/E7 oncogenes for elucidating the mechanism of REBACIN® in the clearance of persistent hrHPV infection. In vitro, after REBACIN® treatment, the growth of both Ca Ski and HeLa cervical cancer cells containing the E6/E7 oncogenes was prevented. In line with this finding is that E6/E7 expression was inhibited, which can be counteracted by the co-application of anti-REBACIN® antibody. These studies demonstrated that REBACIN® can effectively inhibit the growth of cervical cancer cells via targeting HPV E6/E7 expression. To further verify this finding in clinic, 108 volunteer patients with persistent hrHPV infections were randomly divided into REBACIN®, recombinant human interferon alpha-2b (Immunological drug control), or no-treatment blank control groups, received intravaginal administration of REBACIN®, interferon or no-treatment every other day for three months, and then followed up for E6/E7 mRNA assay. In REBACIN® group, 68.57% of patients showed complete clearance of HPV E6/E7 mRNA, which was significantly higher compared to 25.00% in the interferon immunological drug control group and 20.00% in blank control group, confirming that REBACIN® is potently efficacious on clearing persistent hrHPV infections via inhibition of HPV E6/E7 oncogenes. Clinical trial registration http://www.chictr.org.cn/historyversionpuben.aspx?regno=ChiCTR2100045911, identifier ChiCTR2100045911.
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Affiliation(s)
- Shu-Guang Zhou
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui, China
| | - Dai-Fei Wu
- Division of Molecular Virology, SR Life Sciences Institute, Clarksburg, MD, United States
| | - Hui Yao
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui, China
| | - Wei-Yu Zhang
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui, China
| | - Feng-Jiao Tian
- Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, China
| | - Guo Chen
- Department of Gynecology, Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui, China,*Correspondence: Chun-Fa Zhang, ; Guo Chen,
| | - Chun-Fa Zhang
- Division of Molecular Virology, SR Life Sciences Institute, Clarksburg, MD, United States,*Correspondence: Chun-Fa Zhang, ; Guo Chen,
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Zhang L, Qi R, Wang L, Jiang F, Pan S, Fu W, Su Z, Gui D. Clinical value of the ThinPrep cytologic test with E6/E7 mRNA detection for cervical cancer screening in disease diagnosis. Diagn Cytopathol 2022; 50:513-517. [PMID: 35912779 DOI: 10.1002/dc.25025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/08/2022] [Accepted: 07/21/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND To investigate the clinical value of the ThinPrep cytologic test (TCT) with the E6/E7 mRNA test for cervical cancer screening in disease diagnosis. METHODS A total of 405 samples from Dazhou Central Hospital from April 2017 to July 2020 were collected, and we conducted a comparative analysis of the diagnostic performance of several test methods both individually andcombination. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve (AUC) were compared by single TCT, E6/E7 mRNA test, and combination methods. The TCT+E6/E7mRNA test was confirmed to have a relatively higher specificity of 80.32% (95% CI: 75.40%-84.48%, both P < 0.001), and AUC value (0.78, 95% CI: 0.73-0.83, and P < 0.001). CONCLUSION The relative diagnostic value may be further improved by the combined detection of TCT and E6/E7 mRNA test. The combined detection of TCT and the E6/E7 mRNA test is expected to become a potential indicator for cervical lesions.
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Affiliation(s)
- Liyi Zhang
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Ruihong Qi
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Lin Wang
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Fengxi Jiang
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Shuguang Pan
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Wei Fu
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Zhanqin Su
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
| | - Dingqing Gui
- Department of Gynecology, Dazhou Central Hospital, Dazhou, People's Republic of China
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Gilbert L, Ratnam S, Jang D, Alaghehbandan R, Schell M, Needle R, Ecobichon-Morris A, Wadhawan A, Costescu D, Elit L, Wang P, Zahariadis G, Chernesky M. Comparison of CINtec PLUS cytology and cobas HPV test for triaging Canadian patients with LSIL cytology referred to colposcopy: A two-year prospective study. Cancer Biomark 2021; 34:347-358. [PMID: 35001877 PMCID: PMC9535599 DOI: 10.3233/cbm-210366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES & METHODS: CINtec PLUS and cobas HPV tests were compared for triaging patients referred to colposcopy with a history of LSIL cytology in a 2-year prospective study. Cervical specimens were tested once at enrollment, and test positivity rates determined. Test performance was ascertained with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3 or worse (CIN3+) serving as clinical endpoints. RESULTS: In all ages, (19–76 years, n= 598), 44.3% tested CINtec PLUS positive vs. 55.4% HPV positive (p< 0.001). To detect CIN2+ (n= 99), CINtec PLUS was 81.8% sensitive vs. 93.9% for HPV testing (p= 0.009); genotype 16/18-specific sensitivity was 46.5%. Specificity was 52.9% vs. 36.6%, respectively (p< 0.001). In all ages, to detect CIN3+ (n= 44), sensitivity was 93.2% for both tests; genotype 16/18-specific sensitivity was 52.3%. Specificity was 48.4% for CINtec PLUS vs. 31.1% for HPV testing (p< 0.001). In patients < 30 years, CINtec was 91.7% sensitive vs 95.8% for HPV testing (p= 0.549). CONCLUSIONS: CINtec PLUS or cobas HPV test could serve as a predictor of CIN3+ with high sensitivity in patients referred to colposcopy with a history of LSIL regardless of age while significantly reducing the number of LSIL referral patients requiring further investigations and follow-up in colposcopy clinics.
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Affiliation(s)
- Laura Gilbert
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | - Sam Ratnam
- Faculty of Medicine, Memorial University, St. John's, Canada.,McMaster University, St. Joseph's Healthcare, Hamilton, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Dan Jang
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | | | - Miranda Schell
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Rob Needle
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | | | - Arnav Wadhawan
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Dustin Costescu
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Laurie Elit
- McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Peter Wang
- Faculty of Medicine, Memorial University, St. John's, Canada
| | - George Zahariadis
- Faculty of Medicine, Memorial University, St. John's, Canada.,Eastern Health, Public Health Microbiology Laboratory, St. John's, Canada
| | - Max Chernesky
- McMaster University, St. Joseph's Healthcare, Hamilton, Canada
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Yang YM, Wang SJ, Wang FY, Chen R, Xiao Q, Kang N, Liao QP. Preliminary study of the use of E6/E7mRNA detection in screening and triage management of HR-HPV infection during pregnancy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1428. [PMID: 34733980 PMCID: PMC8506710 DOI: 10.21037/atm-21-4026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022]
Abstract
Background Detection of E6 and E7 mRNA load of high-risk human papillomavirus (HR-HPV) infection during pregnancy was compared with conventional cytopathology and DNA detection by pathological examination as colposcopy to evaluate the application of E6 and E7 mRNA detection in the diagnosis and management in HR-HPV infection for high -grade cervical lesions during pregnancy. Methods From January 2014 to June 2019, 1,058 pregnant women of childbearing age who were filed for regular obstetrics in the Department of Obstetrics and Gynecology, Xuanwu Hospital of Capital Medical University, were separately assessed using cervical liquid-based cytology and HPV DNA detection. If the results were abnormal, colposcopy was performed as a follow-up. The presence of HR-HPV E6/E7 mRNA fragments was detected through the HR-HPV E6/E7 mRNA test, and monitored at the same time as colposcopy. The diagnostic efficacy of the HR-HPV DNA test versus the HR-HPV E6/E7 mRNA test for high-grade cervical lesions during pregnancy was compared. Results The positive rate of HR-HPV E6/E7 mRNA detection in the overall cervical intraepithelial neoplasia (CIN) and above during pregnancy was lower than that with HR-HPV DNA detection, and there was a significant statistical difference between the two methods. In CIN I and normal or inflammatory results, the positive rate of HR-HPV E6/E7 mRNA detection was lower than that of HR-HPV DNA detection, while in the results of CIN II and CIN III, the positive rate of the two was not significantly different. HR-HPV E6/E7 mRNA detection is the same as HR-HPV DNA detection, both of which increased with the severity of cervical lesions, and the positive rate increased. In cases of maintenance or progression of cervical lesions, the positive rate of HR-HPV E6/E7 mRNA detection during pregnancy can reach 81.8%. High-grade cervical lesions during pregnancy had a higher rate of reversal to a lower level after delivery. Conclusions The results suggested that the use of HR-HPV E6/E7 mRNA detection in cases of positive HR-HPV DNA detection can significantly improve the diagnostic specificity of CIN II and above high-grade cervical lesions.
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Affiliation(s)
- Yong-Mei Yang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shi-Jun Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng-Ying Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rui Chen
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Qun Xiao
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ning Kang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qing-Ping Liao
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China
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Dlamini Z, Mbele M, Makhafola TJ, Hull R, Marima R. HIV-Associated Cancer Biomarkers: A Requirement for Early Diagnosis. Int J Mol Sci 2021; 22:ijms22158127. [PMID: 34360891 PMCID: PMC8348540 DOI: 10.3390/ijms22158127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Globally, HIV/AIDS and cancer are increasingly public health problems and continue to exist as comorbidities. The sub-Saharan African region has the largest number of HIV infections. Malignancies previously associated with HIV/AIDS, also known as the AIDS-defining cancers (ADCs) have been documented to decrease, while the non-AIDS defining cancer (NADCs) are on the rise. On the other hand, cancer is a highly heterogeneous disease and precision oncology as the most effective cancer therapy is gaining attraction. Among HIV-infected individuals, the increased risk for developing cancer is due to the immune system of the patient being suppressed, frequent coinfection with oncogenic viruses and an increase in risky behavior such as poor lifestyle. The core of personalised medicine for cancer depends on the discovery and the development of biomarkers. Biomarkers are specific and highly sensitive markers that reveal information that aid in leading to the diagnosis, prognosis and therapy of the disease. This review focuses mainly on the risk assessment, diagnostic, prognostic and therapeutic role of various cancer biomarkers in HIV-positive patients. A careful selection of sensitive and specific HIV-associated cancer biomarkers is required to identify patients at most risk of tumour development, thus improving the diagnosis and prognosis of the disease.
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Zhang SW, Luo RZ, Sun XY, Yang X, Yang HX, Xiong SP, Liu LL. Co-expression of SOX2 and HR-HPV RISH predicts poor prognosis in small cell neuroendocrine carcinoma of the uterine cervix. BMC Cancer 2021; 21:332. [PMID: 33789601 PMCID: PMC8011148 DOI: 10.1186/s12885-021-08059-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Small cell neuroendocrine carcinoma of the uterine cervix (SCNEC) is a rare cancer involving the human papilloma virus (HPV), and has few available treatments. The present work aimed to assess the feasibility of SOX2 and HPV statuses as predictive indicators of SCNEC prognosis. METHODS The associations of SOX2 and/or high-risk (HR)-HPV RNA in situ hybridization (RISH) levels with clinicopathological characteristics and prognostic outcomes for 88 neuroendocrine carcinoma (NEC) cases were analyzed. RESULTS Among these patients with SCNEC, SOX2, P16INK4A and HR-HPV RISH expression and SOX2/HR-HPV RISH co-expression were detected in 68(77.3%), 76(86.4%), 73(83.0%), and 48(54.5%), respectively. SOX2-positive and HR-HPV RISH-positive SCNEC cases were associated with poorer overall survival (OS, P = 0.0170, P = 0.0451) and disease-free survival (DFS, P = 0.0334, P = 0.0309) compared with those expressing low SOX2 and negative HR-HPV RISH. Alternatively, univariate analysis revealed that SOX2 and HR-HPV RISH expression, either separately or in combination, predicted the poor prognosis of SCNEC patients. Multivariate analysis revealed that the co-expression of SOX2 with HR-HPV RISH may be an independent factor of OS [hazard ratio = 3.597; 95% confidence interval (CI): 1.085-11.928; P = 0.036] and DFS [hazard ratio = 2.880; 95% CI: 1.199-6.919; P = 0.018] prediction in SCNEC. CONCLUSIONS Overall, the results of the present study suggest that the co-expression of SOX2 with HR-HPV RISH in SCNEC may represent a specific subgroup exhibiting remarkably poorer prognostic outcomes compared with the expression of any one marker alone.
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Affiliation(s)
- Shi-Wen Zhang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pathology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 51800, China
| | - Rong-Zhen Luo
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xiao-Ying Sun
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xia Yang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Hai-Xia Yang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Si-Ping Xiong
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Li-Li Liu
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
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Onyango CG, Ogonda L, Guyah B, Shiluli C, Ganda G, Orang'o OE, Patel K. Novel biomarkers with promising benefits for diagnosis of cervical neoplasia: a systematic review. Infect Agent Cancer 2020; 15:68. [PMID: 33292364 PMCID: PMC7670699 DOI: 10.1186/s13027-020-00335-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cervical cancer screening is slowly transitioning from Pappanicolaou cytologic screening to primary Visual Inspection with Acetic Acid (VIA) or HPV testing as an effort to enhance early detection and treatment. However, an effective triage tests needed to decide who among the VIA or HPV positive women should receive further diagnostic evaluation to avoid unnecessary colposcopy referrals is still lacking. Evidence from experimental studies have shown potential usefulness of Squamous Cell Carcinoma Antigen (SCC Ag), Macrophage Colony Stimulating Factor (M-CSF), Vascular Endothelial Growth Factor (VEGF), MicroRNA, p16INKa / ki-67, HPV E6/E7/mRNA, and DNA methylation biomarkers in detecting premalignant cervical neoplasia. Given the variation in performance, and scanty review studies in this field, this systematic review described the diagnostic performance of some selected assays to detect high-grade cervical intraepithelial neoplasia (CIN2+) with histology as gold standard. METHODS We systematically searched articles published in English between 2012 and 2020 using key words from PubMed/Medline and SCOPUS with two reviewers assessing study eligibility, and risk of bias. We performed a descriptive presentation of the performance of each of the selected assays for the detection of CIN2 + . RESULTS Out of 298 citations retrieved, 58 articles were included. Participants with cervical histology yielded CIN2+ proportion range of 13.7-88.4%. The diagnostic performance of the assays to detect CIN2+ was; 1) SCC-Ag: range sensitivity of 78.6-81.2%, specificity 74-100%. 2) M-CSF: sensitivity of 68-87.7%, specificity 64.7-94% 3) VEGF: sensitivity of 56-83.5%, specificity 74.6-96%. 4) MicroRNA: sensitivity of 52.9-67.3%, specificity 76.4-94.4%. 5) p16INKa / ki-67: sensitivity of 50-100%, specificity 39-90.4%. 6) HPV E6/E7/mRNA: sensitivity of 65-100%, specificity 42.7-90.2%, and 7) DNA methylation: sensitivity of 59.7-92.9%, specificity 67-98%. CONCLUSION Overall, the reported test performance and the receiving operating characteristics curves implies that implementation of p16ink4a/ki-67 assay as a triage for HPV positive women to be used at one visit with subsequent cryotherapy treatment is feasible. For the rest of assays, more robust clinical translation studies with larger consecutive cohorts of women participants is recommended.
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Affiliation(s)
- Calleb George Onyango
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya.
| | - Lilian Ogonda
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - Bernard Guyah
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - Clement Shiluli
- Department of Biomedical Sciences and Technology, Maseno University, P.O Box Private Bag, Maseno, Kenya
| | - Gregory Ganda
- Department of Clinical Services, Division of Gynecology / Oncology, Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), P.O Box 849, Kisumu, Kenya
| | - Omenge Elkanah Orang'o
- Department of Reproductive Health, Division of Gynecology / Oncology, Moi University, P. O Box 4606, Eldoret, Kenya
| | - Kirtika Patel
- Department of Immunology, Moi University, P.O Box 4606, Eldoret, Kenya
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Liu J, Yang T, Hu Y, Ye C. The value of HPV E6/E7 mRNA quantitative analysis in distinguishing high-grade cervical squamous intraepithelial lesions from low-grade cervical squamous intraepithelial lesions. J Virol Methods 2020; 289:114014. [PMID: 33188806 DOI: 10.1016/j.jviromet.2020.114014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
A quantitative assay for HPV E6/E7 mRNA may be a valuable tool for cervical cancer screening. The purpose of this study is to compare the expression levels of HPV E6/E7 mRNA in high-grade cervical squamous intraepithelial lesion (HSIL) and low-grade squamous intraepithelial lesions (LSIL) and to determine a new method that can be used to distinguish cervical squamous intraepithelial lesions. Routine cytology, HR-HPV E6/E7 mRNA, histology, and p16 immunohistochemistry were performed in tissues from 142 patients with cervical squamous intraepithelial lesions. Significant differences were observed between the E6/E7 mRNA copy number values between the LSIL and HSIL cases (Mann-Whitney U-test, P < 0.001). The optimal cut-off value (≥9,222.00 copies/mL) was determined using the receiver operating characteristic curve to predict diagnostic performance. Out of the 161 samples tested in this study, four cases were classified cytologically as HSIL but had normal histology. The E6/E7 copy numbers in these cases were all higher than 9,222 copies/mL. Therefore, a quantitative assay for HPV E6/E7 mRNA may be a valuable tool that can be used to distinguish HSIL and LSIL, especially for those with HSIL, for which samples are not obtained by biopsy, or when HSIL is difficult to distinguish by morphology and p16 immunohistochemistry.
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Affiliation(s)
- Jixuan Liu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Teng Yang
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yubo Hu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Cong Ye
- Department of Obstetrics and Gynecology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130021, China.
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