Clinical Application Of Improved Three-step Technique On The Diagnosis And Treat Of Cervical Lesions

ObjectivesTo value the clinical application of improved three-step technique (TCT/HPV→colposcopy→ervical pathology) on the diagnosis and treat of cervical leisions.Methods936 cases of gynecological outpatient were collected during July 2008-May 2010 at the Shandong University Qilu Hospital and other hospitals aged 30-60 years, mean age 37.45 years, The subjects did not have a history of hysterectomy or cervical surgery. All the subjects were non-pregnant and 24-hour asexual. They all acceped TCT and HR-HPV DNA testings. Colposcopy was performed on 329 patients of abnormal TCT (≥ASCUS) or (and) HR-HPV-positive or clinical suspicion of cervical lesions. Colposcopically directed multi-point biopsies and/or ECC or LEEP were performed according to the colposcopy. If the cervical cytology was ASCUS, ASC-H, LSIL, or HR-HPV positive and the colposcopy was satisfying, colposcopically directed biopsies were available. Otherwise multi-point biopsies and ECC wre performed. Select colposcopically directed biopsy if the cervical cytology results were HSIL, AGC with satisfying colposcopy and visible lesions. When there was no visible lesions, select the transformation zone near the new scale-columnar junction 3,6,9,12 and get the materials. Directly select the line diagnosis of cervical LEEP resection or the multi-point biopsy and ECC if the colposcopies were not satisfying and the patients involved had no conization contraindications. Perform LEEP on 184 patients whose biopsy pathology results were CIN. With self-control method, compare the pathology results between colposcopically directed biopsy and LEEP and value the clinical application of improved three-step technique on the diagnosis and treat of cervical leisions.Results:Of the 936 samples there were 342 cases of HPV-DNA positive(36.5%) and 304(32.5%) cases of abnormal TCT testings. With the rise of cytology level HPV infection rates rise too. The rate of HPV infection in ASCUS, ASC-H, LSIL, HSIL were respectively 40.85,56.86%,81.25% and 90.20%. Cervical dysplasia screening, The single detection rates of TCT and HPV were 32.5% and 36.0%. The rate increased to 47.3% when the two methods were used together. Comparing Pathology, TCT and HPV test results, the detection rate of CIN III and above was the highest in the patients with both positive TCT and HPV. None of CIN III and above lesions was found in cases with negative TCT and HPV. P<0.01, the difference was statistically significant. Of the 51 patients with HSIL, there were 46 cases of CIN 1 and above the level of disease,44 cases of CINⅡand above the level,28 cases of CINⅢand above the level.46 cases were HPV positive. While comparing 184 cases of colposcopically directed biopsy and LEEP biopsy, the full compliance rate was 61.96%(114/184).23 patients had diagnosis of a higher level, accounting for 12.50%; 47 had diagnosis of 1-2 grade lower level, accounting for 25.54%. Spearman rank correlation analysis of two methods of diagnosis was positively correlated (r= 0.702, P= 0.000). Wilcoxon test of these two methods was significant (P= 0.017).Conclusionsl.The combination of TCT and HR-HPV DNA testing can improve the detetion rate of cervical lesions, particularly high-grade CIN.2. If there are not contraindications of cervical conization, Patients HSIL and HPV-positive can accept LEEP directly, a complete diagnosis and treatment.3. Reasonable application of improved three-step technique can detect cervical intraepithelial neoplasia and cervical cancer early. Individually targeted treatment can be taken and then reduce over-diagnosis or under-diagnosis, over-treatment or inadequate treatment. The life quality of of patients with cervical lesions can be improved.