Risk Factors For Postoperative Pathological Escalation Of Cervic HSIL And Exploration Of Ways To Improve The Accuracy Of Preoperative Diagnosis

Objective: The purpose of this retrospective study is to determine the risk factors related to the postoperative pathological escalation of high-grade squamous intraepithelial lesions into invasive cancer,and find other problems that may affect the accuracy of preoperative diagnosis,so as to provide direction and basis for clinical work on how to improve the accuracy of preoperative diagnosis.Methods: 62 patients with complete medical records from March 2014 to July2021 in the First Hospital of Lanzhou University,who underwent surgical treatment for high-grade squamous intraepithelial lesions of the cervix and whose postoperative pathological results suggested invasive carcinoma of the cervix,were collected as the research group,and 67 patients with high-grade squamous intraepithelial lesions after surgery under the same medical conditions at different stages were randomly selected as the control group.SPSS 22.0 software was used to statistically analyze the correlation between the following factors and postoperative pathological escalation events: patient’s age,menopause,delivery times,cervical cytology screening results,infection of human papillomavirus,acetic acid test results,iodine staining results,contact bleeding during the course of disease,whether vaginitis was definitely diagnosed during the course of disease,whether glands were involved in preoperative pathology,and the type of cervical transformation zone.According to the statistical results,the risk factors related to postoperative pathological escalation were determined.Frequency analysis was used to find other events that may affect the accuracy of diagnosis before operation.Result:In the upgrade group,11 cases（17.74%）received cervical conization,which could not completely remove invasive cancer.The univariate correlation test showed that: age（2 = 7.098,P = 0.008）,HPV infection（2 = 4.321,P = 0.0038）,type of transformation zone（2 = 6.808）The results of cervical cytology,which is widely used in screening cervical epithelial lesions,have no correlation with postoperative pathological escalation（P = 0.289）.Whether the patient is menopausal,the number of delivery,whether there is contact bleeding in the course of the disease,whether the gland is involved in the preoperative pathology,the results of acid test and iodine staining have no correlation with the postoperative pathological escalation events（P >0.05,statistically insignificant）;The results of frequency analysis showed that 63.86%of all tested genotypes were infected with HPV 16.The positive rate of acetic acid was 82.17% in all subjects.Conclusion: 1.The accuracy of preoperative diagnosis with colposcopy-guided biopsy as the main means is limited;2.Patients who are older,infected with human papillomavirus,with type III transformation zone and diagnosed as vaginitis in the course of disease are more likely to have pathological escalation after operation;3.HPV 16 is still the main HPV infection genotype in patients with high-grade squamous intraepithelial lesions and invasive cancer,and the specificity of cervical cytology diagnosis is not ideal.There is a high false positive rate in acetic acid test applied to cervical cancer screening.