Evaluation Of Cervical Cytology And Reasonable Management Of Women With Cervical Intraepithelial Neoplasia

Objective: To determine the accuracy and application of cervical cytology; To determine reasability of treatment, cause and preventive ways of over-treatment to cervical intraepithelial neoplasia(CIN). Methods: Three hundred and eighty-two patients with cervical cytological abnormalities and one hundred and ninety patients with cervical intraepithelial neoplasia diagnosed and treated at the Second West China Hospital of Sichuan university in 2003 were retrospectively analysed, focusing on clinical management of cervical intraepithelial neoplasia and comparative study in pathology among preoperative multiple biopsies, frozen section examination in operation and postoperative biopsies; some of cytological specimens were re-interpreted by pathologist, k value was calculated for comparison of the interpretations between the cytotechnologist and pathologist.Results: 1. Of 382 patients with cervical cytological abnormalities ,the number of young women(<35 years) was 117(30.6%);The positive predictive rate for lesions severer than CIN â…  of ASC,LSIL and HSIL were40.1%,36.2% and 72.0%,respectively, The negative predictive rate of cervical cytology was 98.9%; the inter-observer reproducibility of cytologic interpretations is fair agreement (k=0.39) . 2. The rate of over-treatment to CIN â…  and CINâ…¡ , â…¢ were 21.7% and 38.0%,respectively. 3. The rate of under-diagnosis of preoperative multiple biopsies was 8.0%(biopsy directed by the naked eye, 11.8%;colposcopically directed biopsy,2.2%), 3 cases of invasive cancer were missed ;After frozen section examination in operation, the rate of under-diagnosis was 4.5% and no case of invasive cancer was missed; The accuracy of frozen section examination with cervical conoid samples was high.Conclusion: 1. We should pay more attention to cervical cancer screening of young women; ASC as well as other cervical cytological abnormalities should perform immediate colposcopy. 2. There was some degree of over-treatment to cervical intraepithelial neoplasia, frozen section examination in operation can decrease under-diagnosis of cervical carcinoma and intraepithelial neoplasia, at the same time, it can prevent partly over-treatment to cervical intraepithelial neoplasia. To patients with cervical intraepithelial neoplasia, cervical, conization may be done before planned hysterectomy to evaluate comprehensively.