Clinical Analysis Of Cervical Intraepithelial Neoplasia In The Case With Non-cervical Factors Hysterectomy

Objective : Cervical intraepithelial neoplasia(CIN) is a group of precancerous lesions that is closely related with the cervix infiltrating carcinoma. Sex disorder,smoking had some correlation with the onset of CIN, but the main factor is HPV infection. CIN reflects the continuous development process in the onset of cervical cancer, the pathological change is from cervical dysplasia (mild→moderate→severe ),carcinoma in situ,early invasive carcinoma to infiltrating carcinoma. There's no special manifestations of CIN, vaginal drainage increase and contact bleeding happen occasionally, after sex life and during gynaecological check-up, normal cervix also accounted for a significant proportion. Signs are not obvious, cervical is smooth or just with local erythema,white epithelium and erosion. CIN's diagnosis should follow the "three staged" program (cytology, colposcope and histopathological) and its treatment should be individualization.Method: The cases were that who underwent hysterectomy not because of cervical factors, but found CIN after operation in the first hospital of Jilin university from Jan.2001 to December.2010. All cases were analyzed by retrospective methods, and compared with the cases that were treated for CIN of the corresponding period, approach the reasons of CIN's misdiagnosis furtherly. For married women, the cerical cytology and HPV testing should be routine examined, and reviewed regularly as well, cervical biopsy was the most reliable methods for the diagnosis of CIN.Results: During 10 years, the detection rate of CIN with non-cervical factors hysterectomy was obviously increased, especially in 2009 and 2010. There were 89 cases totally, including 70 CINⅠc ases(79%), 7 CINⅠ cases(8%), 3 CINⅢcases(3%) and 7 CINⅠ-Ⅰcases(8%), 2 CINⅠ-Ⅲcases(2%). By chi-aquare and P test statistic methods, there were statistical differences between the five years before and after, explained that the detection rate of CIN with non-cervical factors hysterectomy was increased obviously in the five years after than before. There were 99 hysterectomy cases for CIN of the corresponding period totally, especially in the nearly five years, including 88 cases for CINⅢ, 11 cases(11.1%) for CINⅠand CINⅠ(including annex diseases) during 2003 to 2008(6 cases for CINⅠand 5 cases for CINⅠ). There were 89 cases which were hospitalized for non-cervical factors .Among them a cerical liquid base cytology inspectors 63, ( 1 HSIL cases, 5 ASC-H cases, 2 ASCUS cases, 3AGC cases,17 inflammation cases and 36 NILM cases), Pap smears cerical 9 cases, (3 highly questionable HSIL cases, 1 atypical cells cases, 4 inflammation cases and 1 NILM cases);17 cases that did . There were 99 hysterectomy cases for CIN ,Among them a cerical liquid base cytology inspectors 30 , ( 3 HSIL cases, 17 ASC-H cases, 5 ASCUS cases, 3 inflammation cases and 2 NILM cases), Pap smears cerical 43 cases, (2 highly questionable HSIL cases, 25 atypical cells cases, 9 inflammation cases and 7 NILM cases);26 cases that did .There is HPV-DNA examination 1 cases of the CIN with non-cervical factors hysterectomy, only 2010 1 patients underwent HPV DNA testing, the results for - 1 case for positive (pathology confirm CIN level II), the more than 88 patients do HPV - not DNA testing;There were 99 hysterectomy cases for CIN ,the HPV-DNA examination 17cases (14 cases were positive and 1 cases were negative).Conclusion: 1,The onset of CIN that did hysterectomy with non-cervical factors but found CIN after operation was increased in the past five years. 2,The morbidity of CIN was gradually increasing and its onset ages had younger trend, the highest peak ranged from 35 to 45. 3,Cervical cytology with abnormal cervical biopsy should take biopsy under vaginal endoscopic the guidance preoperatively ,in order to improve the diagnosis of CIN and avoid misdiagnosis.4,High-risk types of HPV infection had closely relationship with cervical intraepithelial neoplasia, combined with TCT check could be the most important index in screening of cervical cancer. 5,the treatment should be individualization.