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

2025 · doi:10.1101/2025.11.10.25339950
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This cross-sectional diagnostic study evaluated whether colposcopy and HPV E6/E7 mRNA testing, compared against biopsy histopathology as the gold standard, could detect precancerous and early invasive cervical lesions in 150 women aged 30–65 undergoing cervical screening at a tertiary hospital in Bangladesh. Colposcopy showed high sensitivity (94.12%) but very low specificity (8.54) with moderate positive predictive value (46.04%) and accuracy (47.33), while HPV E6/E7 mRNA testing showed high specificity (93.9%) and PPV (78.3%) but low sensitivity (26.5%) and moderate accuracy (63.3); a significant correlation was reported between E6/E7 mRNA positivity and biopsy-confirmed high-grade lesions (p = 0.001). The authors explicitly frame colposcopy as sensitive but nonspecific and E6/E7 mRNA as more specific and accurate for higher-grade disease, though the sensitivity of mRNA testing was low. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background Cervical 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. Methods This 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. Findings Colposcopy 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. Conclusions Colposcopy 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.
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Abstract

Background Cervical 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.

Methods

This 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. Findings Colposcopy 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.

Conclusions

Colposcopy 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. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical clearance was approved by Institutional Review Board (IRB) of Bangladesh Medical University (IRB registration Number-4628 Date-01.10.2023) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes

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