Risk evaluation of cervical cancer progress by screening human papillomavirus DNA, E6/E7 mRNA and protein, and cell free ferrous protoporphyrin

Human papillomavirus (HPV) infection is a major cause of cervical cancer. We sought to evaluate the efficiency of HPV DNA, E6/E7 mRNA and protein, and cell free ferrous protoporphyrin (FH) tests for cervical cancer screening. Cervical specimens were collected from 186 Chinese women simultaneously undergoing biopsy examination and HPV DNA, E6/E7 mRNA and protein, and FH tests. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for each test during the progress of cervical cancer. Diagnostic efficiencies were compared between the HPV and FH tests. Of the 186 participants, 83 women (44.6%) had negative (cervical intraepithelial neoplasia grade 0 [CIN0 or no CIN]) or low-grade squamous intraepithelial lesions (CIN1), and 103 women (55.4%) had high-grade squamous intraepithelial lesions (HSILs [CIN2/3]) or squamous cell carcinomas (SCCs). E6/E7 protein staining produced the lowest sensitivity (65.0%) and the highest specificity (86.7%) for identifying CIN2+ samples (HSILs and SCCs), with an area under the curve (AUC) of 0.759 (95% CI: 0.689-0.829). In contrast, the DNA test (AUC = 0.667, 95% CI: 0.587-0.748) produced the highest sensitivity (96.1%) and the lowest specificity (37.3%). HPV E6/E7 mRNA detection (sensitivity 91.3%, specificity 47.0%, PPV 68.1%, and NPV 81.3%; AUC = 0.691, 95% CI: 0.612-0.770) and FH tests (sensitivity 90.3%, specificity 45.8%, PPV 67.4%, and NPV 79.2%; AUC = 0.680, 95% CI: 0.601-0.760) were both better commercial diagnostic tools than the DNA-based assay for cervical cancer screening in the clinic. Thus, the degree of FH substances is an efficient and cost-effective predictor to estimate the progress of cervical cancer.