Analysis Of Clinicopathological Characteristics Of Thinprep Missed Cases In Cervical Cancer Screening

ObjectiveSummarize the clinicopathological characteristics of TCT-negative cervical intraepithelial neoplasia(CIN)and cervical cancer in cervical cancer screening.Investigate the high-risk missing factors of TCT missed cervical intraepithelial neoplasia and cervical cancer.MethodsIn this study,we enrolled 451 histological proved CIN or cervical cancer outpatient women who had Thinprep test before cervical biopsy in the second affiliated Hospital of Chongqing Medical University from January 2019 to December 2019.They were divided into two groups according to their preoperative TCT results: TCT negative group(n = 231)and TCT positive group(n = 220).the clinicopathological characteristics between those two groups were retrospectively analyzed.Statistically significant characteristics were analyzed by multivariate logistic regression analysis to explore the high-risk missing factors of TCT missed CIN and cervical cancer.Results1.The clinicopathological characteristics of TCT negative CIN and cervical cancer1)231 TCT negative CIN and cervical cancer patients were significantly younger and had fewer gravidity than TCT positive patients,the HPV positive rate,the lesion area and lesion involved quadrants number under colposcopy were also lower than TCT positive patients,while the number of patients with clinical symptoms and cervical treatment history were higher than those in TCT positive patients,there were statistically significant differences.(P<0.05).The number of biopsies proved low-grade squamous intraepithelial lesions(LSIL),negative histopathology of endocervical curettage(ECC)and cervical conization was higher than those of TCT positive group,there were statistically significant differences(P<0.05).2)Comparing with TCT positive cervical cancer patients,the 8 TCT negative cervical cancer patients had less portion of symptomatic patient,more portion of low-grade CIN colposcopy impression and conization detected cancer.There were 4 squamous cell carcinoma,3 adenocarcinoma and 1 adenosquamous carcinoma in them,the adenosquamous ratio(3:4)was higher than that of TCT positive patients(2:17).The FIGO stage of TCT negative cervical cancer include 3 IA1,3 IB1,1 IIIB and 1 IIIC.2.Analysis of the high-risk missing factors of TCT missed CIN and cervical cancer.Age less than 35 years old,less than 3 gravidities,lesion / cervical area less than 50%,having clinical symptom and cervical treatment history,negative HPV and biopsy proved LSIL were the high-risk missing factors of TCT missed CIN and cervical cancer.The age,gravidity and lesion area were inversely proportional to the TCT false negative risk,The clinical symptoms and cervical treatment history were proportional to the TCT false negative risk.The risk of TCT false negative from high to low was HPV-negative,16/18 HPV infection,other high risk HPV infection,and low risk HPV infection.ConclusionsIn primary cervical cancer screening,TCT missed CIN and cervical cancer patients were significantly younger and had fewer gravidity,higher proportion of having clinical symptoms and cervical treatment history,lower HPV positive rate,smaller lesion area and less lesion involved quadrants number under colposcopy,more cervical biopsy proved low-grade intraepithelial lesions and higher proportion of negative ECC and cervical conization.For TCT-negative patients with clinical symptoms and cervical treatment history,comprehensive analysis about TCT false negative risk based on their age,gravidity number,HPV and colposcopy characteristics should be done.