Comparative Study Between HPV E6/E7 mRNA Test and HPV DNA Test in Detecting Cervical Pre-cancer

Abstract

Background: Cervical cancer remains a major health burden in low-resource countries, such as Bangladesh. Persistent high-risk HPV infections, particularly HPV 16 and 18, are the principal etiological factors. Although HPV DNA tests are widely used, they often lack specificity, leading to overtreatment. HPV E6/E7 mRNA testing offers improved specificity by identifying active oncogene expression, potentially serving as a better screening tool than HPV DNA testing. This study aimed to compare the diagnostic performances of the HPV E6/E7 mRNA and HPV DNA tests in detecting cervical pre-cancer in VIA-positive women.

Methods: This cross-sectional analytical study was conducted from November 2023 to January 2025 at BSMMU, Dhaka. A total of 264 VIA-positive women were purposively enrolled. Cervical samples were collected and tested for both HPV DNA and E6/E7 mRNA. Colposcopy followed by Histopathological analysis of the biopsy specimens was performed in every participant. The diagnostic performance metrics, including sensitivity, specificity, accuracy, PPV, NPV, +LR, -LR and Youden Index, were calculated using SPSS v25.

Results: The HPV DNA and mRNA positivity rates were 34.47% and 28.79%, respectively. E6/E7 mRNA showed higher specificity (96.9% vs. 82.2%), accuracy (up to 97%), and PPV for detecting CIN II+ lesions. mRNA positivity increased with lesion severity and was 100% in SCC cases. The Youden Index was consistently higher for mRNA testing. The kappa value between the tests was 0.555, indicating a moderate agreement.

Conclusion: E6/E7 mRNA testing exhibited superior diagnostic performance compared to HPV DNA testing in identifying clinically significant cervical lesions. Integrating mRNA testing into cervical screening programs could reduce unnecessary interventions.