| Objective:The possible risk factors of pathological escalation to cervical cancer in patients with high-grade cervical squamous intraepithelial lesion(HSIL)after conization were retrospectively analyzed to provide reference for preoperative evaluation and targeted treatment to reduce the rate of missed diagnosis of cervical cancer.Methods:A total of 363 patients with HSIL admitted to the first Hospital of Jilin University from January 2020 to December 2022 were retrospectively analyzed.According to the pathological return after conization,49 patients with cervical cancer were treated as upgrade group,and 314 patients with HSIL or LSIL or no intraepithelial lesions were treated as non-upgrade group.In order to determine the clinical risk factors of pathological escalation after HSIL cone resection,SPSS 26.0 software was used to compare the two groups of patients’ age,mode of operation,number of pregnancy,frequency of delivery,menopause,mode of delivery,contact bleeding during the course of disease,preoperative involvement of glands,type of cervical transformation zone,HPV infection,TCT results,tumor marker SCC results,acetic acid test results,smoking history,whether the gynecological color ultrasound indicated that there were abundant blood flow signals in the cervix and whether there was an intrauterine device.Results:(1)Among the 363 patients,the age of the upgrade group was 27-67 years old,with an average age of 44.12±10.586,and that of the non-upgrade group was 18-69 years old,with an average age of 37.06 ±9.138.There was significant difference in age between the two groups(P>0.05).Among them,there were 34 menopausal patients and 13(38.2%)patients in the upgrade group.There was significant difference in menopause between the two groups(P<0.05).(2)Among the 363 patients,229 were less than 3 pregnancies,including 27 in the upgrade group(11.8%),289 in less than 2 deliveries,including 39 in the upgrade group(13.5%).309 patients had delivered,including 183 patients with spontaneous delivery,29 patients with upgrade group(15.8%),124 patients with cesarean section and 18 patients with upgrade group(14.5%).There were 2 patients who experienced both natural delivery and cesarean section,and no one upgraded pathologically after operation(0.0%).The results showed that there was no significant difference in number of pregnancy,frequency of delivery and mode of delivery between the two groups(P>0.05).(3)Among the 363 patients,309 underwent cold knife conization(CKC)and 54 underwent loop electrosurgical excision procedure(LEEP).40 of the CKC patients had postoperative pathological escalation(12.9%),and 9 of the LEEP patients had postoperative pathological escalation(16.7%).The results showed that there was no significant difference between the two groups(P > 0.05).(4)Among the 363 patients,55 had contact bleeding,of which 17(30.9%)were in the upgrade group,and the difference was statistically significant(P<0.05).(5)Among the 363 patients,352 patients were examined by colposcopy before operation,including 205 cases of type I transformation area,18 cases were upgraded(8.8%),69 cases of type II transformation area,11 cases were upgraded(15.9%)and78 cases of type III transformation area,16 cases were upgraded(20.5%).The difference was statistically significant(P<0.05).(6)All the 363 patients were tested for HPV and TCT.In HPV test,8 of them were negative in HPV test,1 was upgraded,accounting for 12.5%,139 were 16 positive,28 were upgraded,accounting for 20.1%,the remaining 12 high risk were positive,12 were upgraded,accounting for 9.6%,91 were mixed positive,and 8 were upgraded,accounting for 8.8%.The statistical results showed that the difference of HPV detection was statistically significant.Among the TCT results,there were 96 NILM,7 upgrades(7.3%),98 ASC-US,12 upgrades(12.2%),62 LSIL,9 upgrades(14.5%),38 ASC-H,4upgrades(10.5%),69 HSIL and 17 upgrades(24.6%).The results showed that the difference of TCT results was statistically significant(P<0.05).(7)Among the 363 patients,175 were involved in the gland before operation,including 27 in the upgrade group(15.4%).There was no significant difference between the two groups(P>0.05).(8)Of the 363 patients included,335 patients were tested for tumor marker SCC,and 9 patients in the upgrade group(23.7%)were positive.There was no significant difference between the two groups(P>0.05).(9)Among the 363 patients,352 patients had acetic acid test results,and 321 patients were positive,of which 39 patients(12.1%)in the upgrade group,the difference was not statistically significant(P>0.05).There were 13 smokers among the 363 patients,including 1 smoker in the upgrade group(7.7%),and the difference was not statistically significant(P>0.05).Among the 363 patients,there were 84 patients with IUD and 13 patients(15.5%)in the upgrade group,the difference was not statistically significant(P>0.05).Among the 363 patients included,there were 38 patients with rich cervical blood flow signals by gynecological color ultrasound,including 11 patients in the upgrade group(28.9%).There was significant difference between the two groups(P<0.05).(10)Multivariate Logistic regression analysis showed that age≥40 years old,contact bleeding during the course of the disease,gynecological color doppler ultrasound indicating abundant blood flow signals in the cervix and HPV 16/18 positive were independent risk factors for pathological upgrading after HSIL coning of the cervix(P<0.05).TCT results,menopause and the type of transforming area were not independent risk factors for pathological escalation.(11)ROC curve indicated that AUC=0.789,95%CI: 0.720-0.858,maximum entry index was 0.449,corresponding sensitivity was 77.8%,specificity was 67.1%.Conclusion:(1)Age ≥ 40 years old,contact bleeding during the course of the disease,gynecological color doppler ultrasound indicating abundant blood flow signals in the cervix and HPV 16/18 positive were independent risk factors for pathological upgrading after HSIL coning of the cervix.Patients with these conditions should be paid attention to before operation to avoid missed diagnosis of cervical cancer.(2)The types of menopause and conversion zone also had guiding significance for pathological escalation after HSIL,but they were not independent risk factors for postoperative pathological escalation.(3)Although TCT results also had guiding significance for pathological upgrading,but they were not independent risk factors,the probability of postoperative pathological escalation when TCT results were HSIL was significantly higher than that of TCT results was NILM.(4)The ROC curve constructed with the predictive variables of Logistic regression model as independent variables had a certain value in judging whether there was pathological upgrade after cervical HSIL cone resection. |
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