Analysis Of High Risk Factors In Lsil Patients With Cervical Biopsy Under Colposcopy

Objective:To explore the influencing factors of lesion persistence and progression in patients diagnosed as LSIL by histopathology of cervical biopsy under colposcopy,as well as the high risk factors of missed diagnosis of HSIL due to biopsy diagnosis of LSIL,so as to provide a more refined,rational and individualized treatment plan for LSIL patients.Methods:According to the specific inclusion and exclusion criteria,570 patients with LSIL who were first diagnosed with LSIL by colposcopy in the second hospital of Jilin University from January 2020 to January 2022 in cervical biopsy histopathology were collected.The relevant data of the patients were collected,including: name,age,menopause condition,number of vaginal deliveries,history of contact bleeding,history of unprotected sexual contact,history of HPV vaccination,history of regular smoking,HPV type,HPV viral load,TCT results,type of transformation zone,lesions involving glands,merger Vaginal intraepithelial lesions and other factors that may affect the outcome of LSIL patients,according to the treatment measures after the initial diagnosis of the patients and the HPV and pathological outcomes within 6 to 12 months,the operators are divided into the missed diagnosis and upgraded group,and the conization not upgraded group.Those without surgery were divided into follow-up persistent infection group,follow-up persistent infection upgrade group,and follow-up negative conversion group;the general data and clinical data among the groups were compared and analyzed,and a single test was performed including Chi-square test,rank sum test,etc.Factor analysis and multi-factor binary Logistic regression analysis,the results were considered statistically significant between the groups when P<0.05,and the influencing factors and independent risk factors of missed diagnosis,persistence or progression of LSIL patients in cervical biopsy under colposcopy were obtained.Results:(1)About 64.0% of the LSIL patients in the total sample size chose to be followed up after the initial diagnosis,and the results after one year of follow-up showed that: 46.6% of the patients turned negative,40.5% of the lesions persisted,and 12.9% of the lesions were upgraded;about 36.0% of the total sample size LSIL patients chose to undergo LEEP directly after the initial diagnosis;the missed diagnosis rate of cervical biopsy under colposcopy accounted for 8.8% of the total sample size.(2)For the patients selected for follow-up,the factors with statistically significant differences between the persistent infection group and the negative conversion group included: menopausal status(P=0.002<0.05),history of contact bleeding(P=0.023<0.05),unprotected contact history(P=0.044<0.05),smoking history(P=0.015<0.05),HPV type(P=0.004<0.05);while P>0.05,the factors with no statistically significant difference between groups include: age,the number of vaginal deliveries,HPV vaccination history,HPV viral load,TCT results,type of transformation zone,lesions involving glands,and vaginal intraepithelial lesions were included;single factors with statistically significant differences were included in the multivariate binary Logistic Regression analysis showed that the independent risk factors for persistent lesion infection included: menopause(P=0.001<0.05,OR=2.990),contact bleeding(P=0.034<0.05,OR=2.101)and HPV mixed infection(P=0.003< 0.05,OR=3.552).(3)Among the patients selected for follow-up,the factors with statistically significant differences between the persistent infection escalation group and the negative conversion group include: history of contact bleeding(P=0.015<0.05),history of unprotected contact(P=0.005<0.05),smoking history(P=0.019<0.05);P>0.05,factors with no statistically significant difference between groups include: age,menopausal status,number of vaginal deliveries,history of HPV vaccination,HPV type,HPV viral load,TCT results,type of transformation zone,lesions involving glands,and vaginal intraepithelial lesion;single factors with statistically significant differences were included in the multivariate binary Logistic regression analysis,and the results showed that the independent risk factors for the escalation of persistent infection in lesions included: History of contact bleeding(P=0.021<0.05,OR=2.800)and history of unprotected contact(P=0.011<0.05,OR=2.524).(4)For patients who choose surgery,the factors with statistically significant differences between the upgraded group of missed diagnosis and the non-upgraded group of conization include: menopausal status(P=0.031<0.05),history of contact bleeding(P=0.031<0.05),HPV type(P=0.016<0.05),TCT result(P=0.018<0.05),transformation zone type(P=0.030<0.05),lesion involving glands(P=0.042<0.05);while P>0.05,group Factors with no statistically significant difference between the two groups included: age,number of vaginal deliveries,history of unprotected sexual contact,HPV vaccination history,smoking history,HPV viral load,and vaginal intraepithelial lesions;the difference was statistically significant the univariate factor was included in multivariate binary Logistic regression analysis,and the results showed that the independent risk factor for missed diagnosis was: TCT cytology result was ASC-H(P=0.044<0.05,OR=5.002).(5)The average negative time of 170 cases of follow-up negative conversion patients was 8.6±3.1 months,and the average negative conversion time of 120 conization negative patients was 6.7±2.6 months.The negative conversion time of the two groups was compared by rank sum test Analysis,the results showed:P<0.05,the differences between the groups was considered statistically significant,and the average rank of the follow-up negative conversion group(167.11)was greater than the average rank of the conization negative conversion group(114.88).Conclusion:(1)Menopause,history of contact bleeding and high-risk Type HPV mixed infection is an independent factor affecting the persistence of LSIL lesions.For those who combine one of the three factors,it is necessary to strengthen the intensity of follow-up and improve the lifestyle to enhance autoimmunity.(2)The history of contact bleeding and unprotected contact history are the main factors of LSIL.It is an independent risk factor for the escalation of persistent infection in lesions.For those who combine one of these two factors,more active treatment measures can be considered,reduce the chance of cervical contact before the cure,pay attention to cleanliness and hygiene during intercourse.At the same time,isolation measures must be used.(3)ASC-H cytology is an independent risk factor for the histopathological diagnosis of LSIL and the missed diagnosis of HSIL,and direct diagnostic conization can be considered for patients with previous cytology of ASC-H.(4)Compared with follow-up observation,diagnostic conization directly after diagnosis can be considered for LSIL patients who do not have the conditions for follow-up,have severe anxiety and fear,urgently require cure,and have no need for fertility,which can play a dual role in diagnosis and shorten the healing time.