| Objective: Through an analysis of the postoperative pathological situation and clinical data of diagnosed as postmenopausal patients with High Grade Cervical Lesions who had a complete hysterectomy operation treatment.This paper analyzes clinical factors related to postoperative pathological escalation in postmenopausal cervical HSIL patients to increase the detection rate of cervical cancer in the screening process.Providing some reference significance and clinical ideas for clinicians evaluate the patients with premenopausal cervical cancer and formulate a reasonable individualized treatment plan for increasing the probability of cervical cancer detected diagnosis.Methods: Retrospective analysis of the clinical data and information of diagnosed as postmenopausal patients with High Grade Cervical Lesions in the department of gynaecology and obstetrics of the second hospital of Jilin University from January 2018 to December 2020,who had a complete hysterectomy operation treatment and whose postoperative pathological were diagnosed as Cervical Carcinoma was pathological upgrading group and whose postoperative pathological were still diagnosed as Cervical Lesions was non-upgrade group.Compared with two groups of patients with cases information and the difference of postoperative pathology,analyze all the data by Excel software and SPSS.26.0 software.Using x2 test for age,menopause,clinical symptoms,hr-HPV results,TCT results,cervical transformation zone type,pregnancy and delivery,gland involvement,imaging examination etc.Single factor analysis was performed on each factor,and the factors with statistically significant difference were included in the logistic regression model for multivariate analysis.The above analysis was conducted at the test level of α=0.05,and P<0.05 were considered statistically significant.Results: 1.All 230 patients age are from 40 to 78.And the average age of 180 patients(78.2%)is 57.84±6.143 and the peak age is 51-65.The average age of patients in the postoperative pathological upgrading group is 58.03±6.728,40-78 years old,and the postoperative pathological non-upgrading group is 57.69±5.617,46-78 years old.There is no significant difference in the mean age distribution between the two groups(P>0.05).Postmenopausal time is between 1 year and 32 years.The average of postmenopausal time in the postoperative pathological upgrading group is 8.69±6.415,and the average of postmenopausal time in the postoperative pathological non-upgrading group is 8.50±6.014,and the total postmenopausal time of them is 8.69±6.415.There is no significant difference in the mean postmenopausal time distribution between the two groups(P>0.05).The average pregnancy time of postoperative pathological upgrading group was 2.85±1.329(0-6 times),the average birth time was 1.71±0.956(0-6 times),the average abortion time was 1.14±1.091(0-5 times),and the average pregnancy time of postoperative pathological non-upgrading group was 2.94±1.612(0-11 times),the average birth time was 1.58±0.847(0-5 times),the average abortion time was 1.35±1.421(0-9 times).There was no significant difference between the two groups in the pregnancy and delivery(P>0.05).2.There were 106 cases(46.9%)had postoperative pathological upgrading of 230 patients.Single factor analysis was performed on factors including age,menopause,pregnancy and delivery,clinical symptoms,hr-HPV results,TCT results,type of cervical transformation,gynecologial examination,gland involvement,imaging examination,and the results were as follows: 2.1 Clinical symptoms 145 cases with no clinical symptoms,46 cases with postoperative pathologically upgrading.73 cases with colporrhagia,52 cases with upgrading.12 cases with abnormal vaginal secretion,8 cases with upgrading.There was a statistically significant difference in the clinical symptoms(P<0.05).2.2 HPV 271 cases had HPV results,there were 165 cases of 16/18 infection,86 cases of postoperative pathologically upgrading.45 cases of other 12 high-risk HPV infection,13 cases of upgrading.7 cases of HPV-negative,2 cases of upgrading.The difference upgrading was statistically significant(P<0.05).2.3 Cervical transformation zone type 164 cases had a vaginoscopy to describe cervical transformation zone type.15 cases of type I,7 cases were upgrading,38 cases of type II,8 cases were upgrading and 111 cases of type III,61 cases were upgrading.The difference upgrading was statistically significant(P<0.05).2.4 SCC 164 cases had SCC results,24 cases of SCC positive,18 cases were upgraded.140 cases of SCC negative,61 cases were upgraded.The difference was statistically significant(P<0.05).3.Multivariate logistic regression analysis of these factors revealed that colporrhagia(OR: 4.298,95%CI: 1.732-10.666)and cervical transformation zone type III(OR: 3.030,95%CI: 1.105-8.312)were independent risk factors for predicting postoperative pathological upgrading in HSIL patients(P<0.05),however,HPV and SCC were not(P>0.05).4.106 cases of postoperative pathological upgrading group,68 cases had conization of cervix and radical treatment of cervical cancer,53 cases of them had frozen pathological examination,the results are as follow: 8 cases of HSIL,45 cases of cervical carcinoma,misdiagnosis rate was 15%.15 cases have no frozen pathological examination,the results are as follow: 1 cases of HSIL,14 cases of cervical carcinoma,misdiagnosis rate was 6.7%.Other 37 cases had complete hysterectomy,21 cases had hysterectomy frozen pathological examination,the results are as follow: 7 cases of HSIL,14 cases of cervical carcinoma,hysterectomy frozen pathological cervical cancer misdiagnosis rate was 33.3%.Only one case had curettage of cervical canals,frozen pathological examination diagnosed as cervical canals carcinoma,had radical treatment of cervical cancer soon afterwards.Conclusion: 1.Clinical symptoms and cervical transformation zone type are independent risk factors for postoperative pathological upgrading in HSIL patients,colporrhagia and cervical transformation zone type III were significantly associated with postoperative pathological progression.2.HPV and SCC are associated with postoperative pathological progression,but they are not independent risk factors for postoperative pathological upgrading in HSIL patients.3.Before hysterectomy,postmenopausal Patients with High Grade Cervical Lesions should have a conization of cervix to avoid cervical carcinoma.Intraoperative frozen pathology has a certain rate of missed diagnosis. |
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