| Objective:A retrospective study was conducted to compare the thin-prep cytology test(TCT)and high risk human papillomavirus(HR-HPV)of patients with high-grade squalor intraepithelial lesion(HSIL),analyze the clinical characteristics of patients with negative TCT or HR-HPV single test,and explore the case characteristics of HSIL patients with negative TCT or HR-HPV single test,so as to improve the positive rate of cervical lesion screening and reduce the missed diagnosis rate of HSIL.Methods:Based on the retrospective analysis,the electronic case system of Dalian Maternal and Child Health Hospital collected 695 patients with complete clinical data of HSIL diagnosed by preoperative colposcopy cervical biopsy and cervical cone resection from July 2019 to July 2020.The age distribution characteristics of HSIL patients were analyzed,and then they were divided into groups according to the results of preoperative cervical cancer prevention screening.TCT negative and HR-HPV positive TCT negative group,78 cases(11.2%),TCT positive and HR-HPV negative HR-HPV negative group,34 cases(4.9%).TCT and HR-HPV positive HSIL patients were positive group,583 cases(83.9%).Age,menopause,age at the beginning of sexual life,recent history of vaginitis,history of cervical treatment,type of conversion area under colposcopy,postoperative pathology,cone margin,previous HPV infection,HR-HPV classification and TCT results were analyzed by X~2test.Results:1.695 patients with HISL,the age distribution was 22-68 years old,the high incidence age range was 46-50 years old(21.4%)and 36-40 years old(16.4%).2.The HR-HPV negative group and the TCT negative group were compared with the positive group,and there were statistically significant differences in age,menopause,recent history of vaginal inflammation,type of transformation area under colposcopically,previous HR-HPV infection,and surgical margin.3.When the age was≤25 years,the number of patients in the three groups was higher than that in the positive group(3.8%)(P=0.025,P=0.002)than that in the HR-HPV-negative group(14.7%)and the TCT negative group(11.5%).When the age was≥46 years,the number of patients in the TCT negative group(73.1%)was higher than that in the positive group(48.0%).The difference was statistically significant(P=0.000);≤25 years old,the sensitivity of TCT and HR-HPV was 75.0%(27/36)and86%(31/36)respectively,≥46 years old,the sensitivity of TCT and HR-HPV was83.9%(298/355)and 94.9%(337/355)respectively.4.In TCT negative group,HR-HPV negative group and positive group,menopause was found in 47 cases(60.7%),18 cases(52.9%)and 211 cases(36.2%).The constituentratio of menopausal patients in TCT negative group and HR-HPV negative group was higher than that of premenopausal women,while the constituent ratio of postmenopausal patients in positive group was lower than that of premenopausal women.The constituent ratio of menopause in TCT negative group and HR-HPV negative group was higher than that in positive group(P=0.001,P=0.049);In menopause,the sensitivity of TCT was 83.0%(229/276),and the sensitivity of HR-HPV was 93.5%(258/276).5.132 patients(19.0%)with recent history of vaginitis,TCT negative group and HR-HPV negative group(74.4%,41.2%)was higher than that in positive group(10.3%),and the difference was statistically significant(P=0.000,P=0.000);The sensitivity of TCT and HR-HPV was 56.1%(74/132)and 89.4%(118/132),respectively,when there was a recent history of vaginal inflammation.6.In the patients with type II transformation area under colposcopy,the constituent ratio of HR-HPV negative group(47.1%)was higher than that of positive group (22.1%).When the transformation area was type III under colposcopy,the constituent ratio of TCT negative group(46.2%)was significantly higher than that of positive group(26.4%).When the transformation area was type I under colposcopy,the constituent ratio of positive group(51.5%)was higher than that of TCT negative group(21.8%)and HR-HPV negative group(20.6%);The sensitivity of TCT was 91.6%(282/308),the sensitivity of HR-HPV was 91.2%(281/308)when it’s type III transformation zone,The sensitivity of TCT was 94.8%(307/324),the sensitivity of HR-HPV was 97.8%(317/324),when it’s type I transformation zone.7.There were 387 patients with CIN II(55.7%)and 308 patients with CIN III(44.3%).The constituent ratio of CIN III cases in HR-HPV negative group(79.4%)was higher than that in TCT negative group(33.3%)and positive group(43.7%),(P=0.000);In CINIII,the sensitivity of TCT and HR-HPV was 91.6%(282/308)and 91.2%(281/308),in CIN II,the sensitivity of TCT was 86.6%(335/387),the sensitivity of HR-HPV was98.2%(380/387).8.There were 55 patients with positive incisal margin after operation,and there was statistical significance in the contrast between the groups;The positive rate of incision margin in negative group was 17.0%(19/112),and that in positive group was 6.2%(36/583).9.Previous HR-HPV infection was statistically significant between the groups (P=0.000,P=0.000);In the negative group,91.1%(102/112)were previously infected with HR-HPV,while in the positive group,27.4%(160/583)were previously infected with HR-HPV.Conclusion:1.The high incidence age range of HSIL is 46-50 years old and 36-40 years old.2.Age,menopause,recent history of vaginitis,type III transformation zone under colpososcopy,and previous HR-HPV infection are the high risk factors for HSIL patients to be single negative for TCT or HR-HPV examination.The results of TCT and HR-HPV typing should be combined in clinical diagnosis and treatment,and the above high risk factors should be considered at the same time to avoid missed HSIL diagnosis.3.The sensitivity of HR-HPV was higher than TCT in perimenopausal period,recent history of vaginal inflammation,and colposcopic type III transformation zone.The higher the grade of cervical lesions,the higher the sensitivity of TCT.4.Patients with TCT or HR-HPV negative were more likely to have positive postoperative surgical margins,and the surgical scope should be mastered during conical surgery to avoid positive postoperative surgical margins. |
PDF Full Text Request