Clinical performance of multiplex high-risk e6 mrna expression in comparison with hpv dna subtypes for the identification of women at risk of cervical cancer

We compared multiplex E6 messenger ribonucleic acid (mRNA) tests using real-time quantitative reverse transcriptase polymerase chain reactions (PCR) with human papillomavirus (HPV) DNA subtypes using a MY11/GP6+ PCR-based reverse-blot assay to identify cervical intraepithelial neoplasias of grade 2 or worse (CIN2+). In total, 684 women were studied, of whom 377 (55%) were diagnosed with CIN2+ histologically. The specificity of HPV mRNA to predict histological CIN2+ was higher than that of HPV DNA (81.3% vs. 44.2%). The odds ratios (ORs) to predict histological CIN2+ in women with positive for type 16, 18, 31, and 45 E6 mRNA or by HPV DNA detection were 7.1 (95% confidence interval [CI] 3.9-13.1) and 2.5 (95%CI 1.9-3.5), respectively, compared to those with negative for E6 mRNA or HPV DNA. The OR to predict histological CIN2+ in women with a cytological grade <CIN2+ and positive for type 16, 18, 31, and 45 E6 mRNA was 9.7 (95%CI 3.2-29.2), compared to those with a cytological grade <CIN2+, and negative for E6 mRNA (OR=1), those with a cytological grade CIN2+, and negative for mRNA (OR=6.9, 95%CI 4.4-10.8), and those with a cytological grade CIN2+ and positive for mRNA (OR=28.0, 95%CI 9.8-79.6). As a HPV DNA positive triage, the OR to predict histological CIN2+ in women with a cytological grade <CIN2+ and positive for mRNA was higher than those with negative for mRNA (OR:12.8 [95%CI 3.6-5.4] vs. OR:1.6 [95%CI 0.9-2.9]). In conclusion, multiplex HPV E6 mRNA detection can be used as a triage for women with cytological grade <CIN2+.