Diagnostic Utility of Colposcopy and HPV E6/E7 mRNA Testing in Detecting Precancerous and Early Invasive Cervical Lesions among Women Undergoing Cervical Cancer Screening in Bangladesh

BackgroundCervical cancer screening aims at detecting precancerous and early invasive lesions to prevent morbidity and mortality. Although colposcopy is a frequently employed visual diagnostic tool with high sensitivity, it has low specificity which often leads to unnecessary biopsies and overtreatment. A possible molecular tool that can enhance the accuracy of the diagnosis is HPV E6/E7 mRNA testing which identifies transcriptionally active viral oncogenes. The study evaluated diagnostic accuracy of colposcopy and HPV E6/E7 mRNA test on women who underwent a cervical screening. MethodsThis cross-sectional study included 150 women aged 30-65 years that underwent a cervical screening at a tertiary hospital in Bangladesh. The baseline parameters like parity, menopausal condition and OCP use were noted. The participants underwent colposcopy and HPV E6/E7 mRNA testing, and the histopathology biopsy was the gold standard of lesion grade. FindingsColposcopy had high sensitivity (94.12%) and very low specificity (8.54) to identify all precancerous and early invasive lesions, which yielded a moderate PPV (46.04%), and accuracy (47.33). Conversely, the E6/E7 mRNA test showed high specificity (93.9%), PPV (78.3%), and low sensitivity (26.5%) and moderate accuracy (63.3%). In the CIN2+ lesions, the sensitivity of colposcopy was very high (90.9 and 98.02), whereas specificity (77.34) and PPV (40.82) scores were low. E6/E7 mRNA test has equal sensitivity (72.7%), good specificity (94.5%), and more accurate (91.3%). The correlation was shown to be significant between E6/E7 mRNA positivity and high-grade lesions that were biopsy-confirmed (p = 0.001), which highlights the clinical relevance of the specified method. It is interesting to note that 15 percent of the women carried high levels of E6/E7 mRNA, which is an indication of transcriptionally active HPV infections. ConclusionsColposcopy is a very sensitive screening test but it lacks specificity. HPV E6/E7 mRNA has better specificity and accuracy particularly to high grade lesions thus makes it a great complementary or triage test. Combining molecular testing with colposcopy has the potential to enhance screening of cervical cancer by enhancing the accuracy of diagnosis, reducing unnecessary biopsies, and steering to acceptable therapeutic treatment.