Strategies To Improve The Accuracy Of Cervical Biopsy In Postmenopausal Women

Background and purposeCervical cancer is one of the major malignant tumors that cause women’s death all over the world.The proportion of cervical cancer and precancerous lesions in postmenopausal women is increasing.The changes of postmenopausal women’s own characteristics,the decline of sex hormones,leading to the atrophy of the reproductive tract,the inward displacement of the scale column junction,the insufficient increase of colposcopy,the difficulty of effective biopsy operation,as well as the decline of the immunity of postmenopausal women,the lack of vaccine protection,the weak awareness of screening and other reasons have led to the decline of the accuracy of cervical disease diagnosis.This study discusses how to improve the accuracy of biopsy in postmenopausal women,and how to deploy strategies in each link of screening to improve the accuracy of screening and diagnosis of cervical diseases in postmenopausal women,so as to reduce missed diagnosis,which can provide some guidance for clinical work.MethodFrom March 2017 to September 2020,126 postmenopausal women were selected as the experimental group and 325 premenopausal women as the control group from the gynecological clinic of the second hospital of Lanzhou University.The complete three-step screening of cervical cancer was completed in both groups.The characteristics of cervical disease screening were statistically analyzed.The clinical characteristics,cervical cytology,cervical human papillomavirus test results and colposcopy results of the two groups were collected,The results of cervical biopsy and(or)vaginal wall biopsy were statistically analyzed.The counting data were expressed in the number of cases and percentage.Using(?)~2test,the difference was statistically significant with p<0.05.Results1.Comparison of clinical characteristics:among the clinical characteristics,the proportion of contact hemorrhage in the menopausal group was 19.05%(24/126)and that in the non menopausal group was 25.85%(84/325),and the difference was not statistically significant((?)~2=2.30,p=0.13);Among the patients with contact hemorrhage,the proportion of lesions diagnosed as above HSIL in the menopausal group was 54.17%(13/24)higher than that in the non menopausal group(33.33%(28/24),and the difference was statistically significant((?)~2=6.62,p=0.01).2.Comparison of TCT:the results of TCT between menopausal group and premenopausal group were statistically significant(P<0.05).The TCT results of the menopausal group showed the highest proportion of ASCUS,which was significantly higher than that of the premenopausal group.62.22%(28/45)of the patients with ASCUS in the menopausal group detected lesions above LSIL,which was higher than16.42(11/67)of the patients with ASCUS in the non menopausal group.The difference between the two groups was statistically significant((?)~2=24.88,p=0.00).3.Comparison of HPV:both groups had higher infection rate of high-risk HPV,but the difference was not statistically significant((?)~2=0.57,p=0.45).In the comparison of HPV high-risk infection types,hpv16/18 infection accounts for a relatively high proportion in the two groups.In the classification and comparison of infection types,the difference is not statistically significant((?)~2=0.26,p=0.61)4.Comparison of age and transformation area:the average age of menopausal group was(54.51±5.43)years old,type I transformation area was 2.38%,type II transformation area was 7.14%,and type III transformation area was 90.48%;The average age of premenopausal group was(41.20±5.745)years old,with 47.08%in type I transformation area,23.08%in type II transformation area and 29.84%in type III transformation area;The occurrence probability of type III transformation area increases with age.The results of different transformation areas in postmenopausal group and premenopausal group are compared,and the differences are statistically significant((?)~2=134.06,p=0.00).The type III transformation area in postmenopausal group is significantly higher than that in premenopausal group.5.Comparison between the adequacy of colposcopy:93.65%(118/126)of the menopausal group had inadequate colposcopy,and 34.77%(113/325)of the premenopausal group had inadequate colposcopy,with a statistically significant difference((?)~2=125.99,p=0.00).6.Comparison of the consistency of colposcopic diagnosis:in the menopausal group,the coincidence rate of colposcopic diagnosis was 73.02%(92/126),the kappa value was 0.46,P<0.05,0.4<kappa<0.6,and the consistency of colposcopic diagnosis and biopsy was medium in the menopausal group.In the premenopausal group,the coincidence rate of colposcopy was 75.69%(246/325),and the kappa value was 0.61,P<0.05,0.6<kappa<0.8.The consistency between colposcopy and biopsy was higher in the premenopausal group.7.Comparison of colposcopy diagnostic consistency of different transformation areas:in the menopausal group,the diagnostic coincidence rate of type i+ii transformation areas was 75.00%(9/12);The diagnostic coincidence of typeⅲtransformation region was 72.81%(83/114);In the premenopausal group,the diagnostic coincidence rate of type I+II transformation area was 80.44%(181/228);The diagnostic coincidence of type III transformation region was 67.01%(65/97).There was no significant difference between the two groups in the diagnostic coincidence rate of type I+II transformation area((?)~2=0.133,p=0.715),and there was no significant difference in the diagnostic coincidence rate of type III transformation area(?)~2=0.996,p=0.318).8.Comparison of results involving vaginal wall:the proportion of vaginal wall involved in menopausal group was 15.07%(19/126),and the proportion of vaginal wall involved in premenopausal patients was 4.92%(16/325).The probability of vaginal lesions involving vagina in menopausal group was higher than that in premenopausal group,and the difference was statistically significant((?)~2=13.08,p=0.00).9.Comparison of ECC results:114 cases of ECC were performed in the menopausal group,with a positive rate of 15.79%(18/114),and 114 cases of ECC were performed in the premenopausal group,with a positive rate of 4.39%(5/114).The positive rate of ECC in the menopausal group was higher than that in the premenopausal group,and the difference was statistically significant((?)~2=7.81,p=0.00).In the menopausal group,ECC was positive in 18 cases,of which 11 cases were consistent with the pathological results of biopsy,and 7 cases were missed,which increased the diagnostic rate by 6.14%(7/114);In the premenopausal group,5cases were ECC positive,3 cases were consistent with the biopsy results,and 2 cases were missed,which increased the diagnostic rate by 1.75%(2/114).Conclusions1.In the screening of cervical lesions,physical examination can find more cervical lesions,and contact bleeding is a specific symptom.Patients with this symptom have a higher probability of diagnosing lesions above HSIL in the cervical screening of postmenopausal women than non postmenopausal women.In TCT examination,the proportion of ASCUS in postmenopausal women is higher than that in premenopausal women,and the probability of cervical lesions is high.For postmenopausal women,physical examination should be strengthened,and the clinical symptoms of contact bleeding should be paid attention to.The existence of ASCUS should not be ignored.The joint detection method of TCT combined with HR-HPV should be recommended,and the management of hpv16/18 should be strengthened.2.With the increase of age,the occurrence of type III transformation area is positively correlated with age,that is,the probability of type III transformation area in postmenopausal population is significantly higher than that in premenopausal group,and the probability of insufficient colposcopy is also higher than that in premenopausal group.The kappa value of the consistency between colposcopy diagnosis and pathological examination in postmenopausal women is 0.46,and the kappa value of the consistency of colposcopy diagnosis in premenopausal women is0.61,It is suggested that the diagnostic efficacy of colposcopy in postmenopausal women is general.In addition to estrogen treatment before examination for postmenopausal women to improve the quality of vaginal examination,senior colposcopy doctors can be selected for special postmenopausal populations to improve the consistency of colposcopy.At the same time,attention should be paid to the expansion of cervical canal,the exposure of transformation area,and the supplement of the third step biopsy to reduce missed diagnosis.3.Patients with cervical lesions in postmenopausal women are more likely to involve the vaginal wall.ECC is an effective supplement to the insufficient colposcopy and cervical biopsy.In this test,the positive rate of ECC in the postmenopausal group is significantly higher than that in the non menopausal group,and the diagnostic rate of postmenopausal women is increased to 6.14%,suggesting that we should pay attention to the application of ECC after colposcopy and comprehensive examination of the lower genital tract to avoid missed diagnosis.