The Application Of Rapid Pathologic Examination In The Diagnosis And Treatment Of Cervical Lesions

Objective:To explore the use of ultrasonic instrument for rapid pathological diagnosis alternative to routine method to diagnose cervical disease and evaluate the application value of rapid pathological examination in the diagnosis and treatment of cervical disease.Object and Methods:A series of 176 patients with cervical lesions underwent colposcopy and had biopsy because of abnormal cytology (ASCUS and above), normal cytology but high-risk HPV test positive, naked eye intuitive for cervical ulcers or suspicious cervical carcinoma from September 2009 to January 2010. Selected patients with a total of 176 cases were divided into A, B groups. A group of 87 patients, cervical biopsy used ultrasonic tissue processing instrument (JYCL-2 ultrasonic tissue processing instrument) to make fast paraffin section for pathologic examination, B group of 89 patients, cervical biopsy sent routine paraffin sections. Patients diagnosed with CINⅡor above lesions accepted LEEP or CKC and / or hysterectomy;Patients with CINI or following lesions mainly were follow-up,some special cases accepted LEEP. The biopsy pathological results, postoperative pathological result, the time for producing paraffin section, the quality of fast paraffin section, the time for pathologist from reading the piece to completing pathological diagnosis, the time from biopsy to obtaining pathology reports and patients satisfaction were recorded to analyse and evaluate the accuracy and application value of rapid pathological diagnosis for cervical lesions.Statistical methods usedχ2 test and t test.Result:Group A had inflammation of 29 cases, CINⅠof 30 cases, CINⅡof 16 cases, CINⅢof 11 cases,and cervical cancer of 1 case(I B1).30 cases had LEEP or CKC and / or hysterectomy. The postoperative pathological findings consistent with biopsy pathologcial diagnosis were 25 cases (83.33%), the disagreement was 5 cases (16.67%), the grade was lowered in 3 cases (10.00%),the grade was elevated in 2 cases (6.67%). Group B had inflammation of 34 cases, CINⅠof 26 cases, CINⅡof 9 cases, CINⅢof 15 cases,and cervical cancer of 5 case (2cases wasⅠA2,3 cases wasⅠB1).32 cases had LEEP or CKC and/or hysterectomy. The postoperative pathological findings consistent with biopsy pathologcial diagnosis were 23 cases (71.88%), the disagreement was 9 cases (28.12%), the grade was lowered in 6 cases (18.75%),the grade was elevated in 3 cases (9.37%). The ultimate diagnosis was the serve one between biopsy and postoperative pathological diagnosis.The actual consistent rate of biopsy and ultimate diagnosis was 28/30 (93.33%) for group A and 29/32 (90.63%) for group B. The difference of rapid and routine pathological method to diagnose cervial lesions had no statistically significance (x2=0.006, P＞0.05).The fast paraffin sections of group A stained well, had a clear structure similar to conventional paraffin sections and could meet the diagnostic requirements. The producers pass rate was 100%(87/87). The long-term deposited wax blocks didn't have organizational depression, crack, mildew. The production time of rapid paraffin for group A was 35-45min, an average of 39.84min, the time for pathologist from reading piece to completing pathological diagnosis was 3-30min, an average of 5.67min,the time from biopsy to obtaining pathology reports was 48-85min, an average of 54.64min; The production time of conventional paraffin for group B was 1-8d, an average of 1.28d, the time for pathologist from reading piece to completing pathological diagnosis was 3-25min, an average of 5.26min,the time from biopsy to obtaining pathology reports was 2-9d, an average of 2.80d;The difference of the time for making paraffin sections and the time from biopsy to obtaining pathology reports in two groups were statistically significant (t=13.18, P＜0.01; t=17.61, P＜0.01), group A was shorter than group B;The difference of the time for pathologist from reading piece to completing pathological diagnosis had no statistically significance (t=0.78, P= 0.97).The ultrasonic tissue processing instrument had embedded devices, and the application of BT agents for biological organization dehydration was safe. While making routine paraffin sections need to purchase paraffin embedding machine, the application of xylene was toxicity and might cause environmental pollution. In group A patients could get pathology reports in a short time so that some patients that need LEEP could receive LEEP on the same day of biopsy. The application of rapid pathologic examination reduced the number of admissions to hospital, costs and psychological stress when waiting,easonable and orderly clinic plans reduced the delay in diagnosis and treatment of cervical disease and patients lost, the convenient treatment program improved the quality of hospital services, patients could accept the standard treatment and follow-up; In group B patients couldn't get pathology reports on the same day of biopsy, it increased the number of admissions to hospital, costs, psychological stress and might delay the diagnosis and treatment.The time of fast pathologic examination was short, high efficiency, and its costs were same to routine method during clinical research (both 300yuan). All patients in group A were satisfied (87/87,100%) with its application.Conclusion:①Rapid paraffin sections technology for cervical tissue has stable quality, which is safe, economical and practical, it has reduced the time of pathological examination and helps clinicians make next clinical decision as soon as possible.②Fast pathologic examination for cervical disease simplifies the treatment process, facilitates the attendance of patients and reduces their economic costs.It may avoid misdiagnosis and over-treatment when combined with the three-step treatment of cervical disease process and will be less delay, accurate and efficient.③Fast pathologic examination for diagnosing and treating cervical disease has high diagnostic accuracy, which is convenient, practical and worth promoting the use in the majority of hospitals.