Evaluation Of Cold-knife Conization Of Cervix In Diagnosis And The Diagnostic Valuation Of P16^INK4A Protein In Cervical Intraepithelial Neoplasia

Objective1. To explore the diagnostic value of the cold-knife cervical conization for cervical intraepithelial neoplasia.2. To explore the expression and clinical significance of P16INK4A protein in cervical intraepithelial neoplasia.Methods:1.90 cases of patients with cervical intraepithelial neoplasia and were operated by cold-knife cervical conization were collected in the Central Hospital of Jilin City from January 2007 to November 2009, a retrospective control study of medical records was made. All patients met the criteria of study and data integrity. All patients were divided into CKC group (group A=60) and CKC+Hysterectomy group (group B=30) according to surgical methods. To compare the difference between two groups in age, parity, preoperative biopsy, conization pathology, hysterectomy pathology and the related factors of residual lesions of uterine specimens. To explore the diagnostic and therapeutic value of the cold-knife cervical conization for cervical intraepithelial neoplasia and explore the risk factors of residual lesions in Uterine specimens after CKC.2.60 cases of patients'cervical lesions paraffin were collected in the department of pathology of the Affiliated Hospital of Jining Medical College from March 2008 to May 2009, all the patients were made cervical biopsy, or Leep knife conization, or cervical surgery.12 cases of cervical squamous cell carcinoma,13 cases of CINI,18 cases of CINⅡ-Ⅲ,17 cases of chronic cervical inflammation. All patients were confirmed by pathology. The expression P16INK4A protein in cervical squamous cell carcinoma, CIN, chronic inflammation of cervical squamous epithelial tissue with Immuno histochemistry(Envision). Results:1. A comparison between CKC pathology and colposcopy biopsy of multi-point A comparison between CKC pathology and colposcopy biopsy of multi-point:total of 64(71.11%) cases were accord, including 12(13.33%) severe cases and 14(15.56%) mild cases of cervical lesions in CKC pathology than that of colposcopy biopsy of multi-point. The diagnose accordance rate of CINI, CINII and CINIII were 62.50%, 57.11% and 82.6% respectively. The diagnose accordance rate of CKC pathology and colposcopy biopsy of multi-point was higher in group CINIII than that of group CINI and group CINII (P<0.05).2. A comparison on age, parity and clinical pathological features between two groupsA comparison on age and parity between two groups:the average age of group A was (42.39±8.3) years, the average age of group B was (47.77±9.10) years, group A was older than group B(P<0.05). The average parity of group A was (1.53±0.79) (0～4), the average parity of group B was (1.07±0.86) (1～6), The average parity of group A was lesser than group B(P<0.05).A comparison on conization pathology between two groups:Group A:8(13.33%) cases of conization pathology were CINⅠ,15 (24.05%) cases were CINⅡ,25(41.33%) cases were CINⅢ,12(20.00%) cases were chronic cervicitis. Group B:1(3.33%) case of conization pathology was CINⅠ,6 (20.00%) cases were CINⅡ,22(75.61%) cases were CINⅢ,1(3.33%) case was microinvasive carcinoma. There were 20(30.00%) cases of low-grade cervical lesions(CINⅠand chronic cervicitis) and 40 (70.00%) cases of high-grade cervical lesions(CINⅡ-Ⅲ) according to conization pathology in group A. There were 1(3.33%) case of low-grade cervical lesions and 29 (96.67%) cases of high-grade cervical lesions according to conization pathology in group B. The lesions level of the patients in group B was higher than that of group A(P<0.01).3. A comparison on CKC pathology and hysterectomy pathology between two groups 30 cases of patients were made CKC then were made hysterectomy, CKC pathology was in fOll compliance with hysterectomy pathology in 29 cases of patients. The CKC pathology was CINⅢinvolving glands in one case of patient, doctor found microinvasion in the patient's hysterectomy pathology, her lesions level bacame higher.4. Residual status of uterine lesions and risk factors analysis after CKC then hysterectomy 3 cases of patients'CKC pathology were CIS involving glands and microinvasive carcinoma, which all were found residual uterine lesions, the total residual rate was 10.00%(3/30).In the 3 cases of patients,1 case of patient's residual lesions were microinvasive carcinoma,1 case of patient's residual lesions were CINIII,1 case of patient's residual lesions were CINI. Doctors have not found uterine lesions in 27 cases of patients.The patients with higher lesions levels, have higher lesions residual rate. The lesions residual rate were 0(0/7),7.15%(1/14),12.50%(1/8) and 100%(1/1) respectively (?1=8.234, P<0.05). There was higher lesions residual rate with involving glands than without involving glands, The lesions residual rate were 33.30%(3/12) and 0(0/18) respectively (?2=6.344, P<0.05).There were no differences of lesions residual rate between patients with parity 1 and parity 2, the lesions residual rate were 12.50%(1/8) and 13.63%(3/22)(?2=0.689, P>0.05).5. There were significent differences in P16INK4A protein expression levels between patients with different cervical lesions, there were significent differences in P16INK4A protein expression levels between chronic cervicitis and CINI, CINI and CINII-Ⅲ, invasive carcinoma and CINI, invasive carcinoma and chronic cervicitis.6. With the increase of lesions levels, from chronic cervicitis to cervical squamous cell carcinoma, P16 A protein expression levels bacame higher and higher, from moderate positive to strong positive(++-+++). The positive levels was helpful for determininmg the lesions levels.Conclusion:1. CKC can not be replaced by multi-point biopsy under colposcopy in the treatment of CIN. it plays a very important role in diagnosis of CIN.2.It need to closely follow-up after CKC treatment of CIN. A high level of lesion an gland involvement are risk factors of residual lesions. The follow-up of these patients should be strengthened.3.The positive expression rates of P16INK4A protein, marked with immunohisto chemistry, are higter at every levels of CIN and cervical squamous cell carcinoma thasn that of chronic cervicitis. The positive expression rate is helpful for distinguishing cervical benign neoplasia and Low-grade intraepithelial neoplasia.4. With the increase of lesions levels, from chronic cervicitis to cervical squamous cell carcinoma, P16INK4A protein expression levels, marked with immunohistochemistry, bacome higher and higher, from moderate positive to strong positive(++～+++). The positive levels are helpful for determininmg the lesions levels.