| Objective:To investigate clinical characteristics of high-grade cervical intraepithelial neoplasia and explore rational method of diagnosis and treatment of the disease.Methods:Analysis of clinical and pathological data of570cases admitted to QiLu Hospital of Shandong University and treated for the first time from January2005to December2010because of high-grade cervical intraepithelial neoplasia diagnosed by biopsy before admission. Analysis of age distribution, results of HPV test and cytology test and choice of surgical treatment methods.Comparative study in pathology among colposcopic biopsies,intraoperative rapid examination and postoperative tissue examination by self-control.Results:1.In these570patients, average age is39.52years old, high incidence happens between35and44years old,57patients have not given birth,41patients are postmenopausal,77cases are complicated by other gynecological disease,321cases are found by physical examination.2.377cases follow "three-step" technique,14cases accepted Pap smear,363cases accepted liquid-based cytology test,in which there are51cases with ASC-US,73cases with ASC-H,63cases with LSIL,138cases with HSIL,5cases with suspected squamous cell cancer,8cases with AGC,25cases with inflammation, sensitivity is93.11%.130cases accepted high-risk HPV test, positive rate is93.08%, sensitivity is93.08%.102cases accepted liquid-based cytology test combined with high-risk HPV test, sensitivity is99.02%.3. In these570cases, accordance rate of preoperative and postoperative pathology is57.19%.Rate of disaccordance is42.81%.Insufficient diagnosis rate is11.40%,in which28cases upgrade to cervical cancer. The missed diagnosis rate of cervical cancer in CINⅡ, CINⅢ is2.01%、5.94%,respectively,there is no statistical difference. The missed diagnosis rate of cervical cancer in CINⅢ、CIS is5.94%,13.79%, respectively, the difference is statistically significant.4.Accordance rate of preoperative pathology and final diagnosis between colposcopically directed biopsy and naked eye directed biopsy is90.06%,82.91%, respectively, the difference is statistically significant. The missed diagnosis rate of cervical cancer between colposcopically directed biopsy and naked eye directed biopsy is3.75%,9.40%, the difference is statistically significant.5.Complete accordance rate of pathology of colposcopically directed biopsy and postoperative pathology is57.17%,rate of disaccordance is42.83%.Insufficient diagnosis rate is9.93%.Accordance rate of pathology of colposcopically directed biopsy and postoperative pathology among different preoperative diagnosis(CIN Ⅱ、 CINⅣ), cytology test results(≥HSIL、≤LSIL),age(≤50years old、>50years old) is36.59%,64.85%,63.64%,52.73%,59.00%,35.48%, respectively, the difference is all statistically significant.Accordance rate of pathology of colposcopically directed biopsy and conization is55.96%,9.42%cases upgrade,in which six cases upgrade to cervical cancer.6.145cases accepted intraoperative frozen section examination.Compared with postoperative pathology accordance rate is69.66%, rate of disaccordance is30.34%, The missed diagnosis rate of cervical cancer is3.45%.7.Rates of patients with different preoperative diagnosis of CINIII and CIS who took conization is74.58%、52.87%, respectively, the difference is statistically significant.8.Telephone follow-up success rate is65.79%,282cases review periodically,59cases terminate review after six months,33cases have never reviewed after operation and one patient died in a car accident.18cases successfully delivered a baby after operation,14patients are high-risk HPV positive persistently and three patients were found CIN due to the abnormal cytology.1cervical cancer patient recur after1year.Conclusion:1. Colposcopically directed biopsy plays an important role in diagnosis of CIN,but it can not replace conization.2. Although intraoperative frozen section examination is somewhat accurate,it can lead to misdiagnosis easily.3.We should choose treatment of high-grade CIN according to multiple factors, treat individually.4.Patients should review periodically with or without hysterectomy and we also need to strengthen the consciousness of patients with follow-up. |
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