The Clinical Value And Treatment Of Mild Abnormal Cervical Cytology

Background:Recent research shows that the incidence of cervical cancer is increasing year by year, and the onset age is becoming younger. It is the issue of extensive concern to standardize screening cervical cancer for early intervention in the gynecologic field. In the three-step diagnosis scheme, the thin prep liquid-based cytology test (TCT) is recognized as an effective primary screening tool for cervical cancer. Among the positive results, mild abnormal is the most common (including atypical squamous cells undetermined significance ASCUS, atypical squamous cells-cannot exelude high gradelesion ASC-H, low grade squamous intraepithelial lesion LSIL, and complementary diagnosed mild abnormality Few ASC.) The pathologic results include inflammation, cervical intraepithelial neoplasia (CIN) and cervical cancer.Although domestic and foreign scholars have done many clinical researches, a unified understanding of accurate screening and treatment of cervical cancer has not yet been achieved, and is therefore worth further research.Purpose:To investigate the pathological significance and rationality of clinical treatment of mild abnormality of the cervical cytology including ASCUS, ASC-H, LSIL and Few ASC.Method:As the object of study, there were1135cases receiving colposcopy in Qilu Hospital of Shandong University and Ji’nan City Fourth People’s Hospital colposcopy chamber from2011March to2012February.472Cases with mild abnormality of cervical cytology were selected. First all cases had the HR-HPV HC Ⅱ test, then received colposcopy. Localized biopsy on suspected lesions, and four-quadrant multiple biopsy or/and ECC were done for cases with biopsy indications but without suspected lesions. Results of the histopathology gave the final diagnosis of mild abnormality of the cervical cytology. Further, clinical treatment and the prognosis were followed in order to analyse the clinical significance of the diagnosis and treatment.Results:Of1135cases undergoing colposcopy,472cases were mild abnormal from the cervical cytological examination. Including237ASCUS,28ASC-H,153LSIL, and54Few ASC cases. The biggest age was75years old and the youngest was20. The average age was40.78years old. The30-49age group had the highest positive rate (72.04%). The average age of CIN Ⅰ was37.35years old, CIN Ⅱ37.84,CIN Ⅲ42.58, cervical cancer45.00. The average age of cervical cancer patients was about8years older than that of CIN Ⅰ patients.472cases had the HR-HPV HC Ⅱ test, of which187cases were positive and285cases were negative. All187cases of positive results had cervix biopsy under colposcopy. The pathologic results of cervix biopsy were:84inflammation,43CIN I,26CIN Ⅱ,30CINⅢ4invasive cervical carcinoma.134cases of negative results had cervix biopsy under colposcopy. The pathologic results of cervix biopsy:94inflammation,23CIN Ⅰ,11CIN Ⅱ,6CINⅢ0invasive cervical carcinoma. The detection rate of CIN (14.04%) was significantly lower than that for the positive group (52.94%). The negative predictive value for cervical carcinoma was100%.The positive results rates of inflammation, CIN Ⅰ, CIN Ⅱ, CINⅢ and cervical carcinoma were47.19%、65.15%、70.27%、83.33%、100%. The positive results rate of HR-HPV increased with the cervical lesions stage.321cases had cervix biopsy under colposcopy. The results included91smooth,76mild cervical erosion,70moderate cervical erosion,39severe cervical erosion,45other(cervical cyst, hypertrophy, vegetations of cervix).The rate of inflammation, CIN, cervical cancer had no statistical significance with different cervical appearance.139CIN and73high-level CIN cases were diagnosed. In ASC-H the rate of CIN、 high-level CIN were50%(14/28)、35.71%(10/28), significantly higher than the other groups. Colposcopy were used to diagnosed191cervicitis,78CIN Ⅰ,31CIN Ⅱ,20CINⅢ,1invasive cervical carcinoma. The pathologic results of cervix biopsy were:178inflammations,66CIN Ⅰ,37CIN Ⅱ,36CINⅢ,4invasive cervical carcinoma. The concordance rate between the two methods was66.36%. The sensitivity and specificity of colposcopy to CIN were67.63%(94/139),82.02%(146/178), respectively, which showed colposcopy had the possibility of over-diagnosis and under-diagnosis.Follow-up status:Except for suggestions of TCT re-examination after6months, no treatment was done for those cases with no biopsy or whose results were inflammation.45CIN Ⅰ were administrated with drug and suggestions of TCT re-examination after6months,21CIN Ⅰ,37CIN Ⅱ and36CINⅢ had LEER4cases of invasive cervical carcinoma received surgery. Before and after LEEP,73histopathological diagnoses were the same (77.66%),14were downgraded (14.90%),7were upgraded (7.44%)。Therefore, cervix biopsy under colposcopy has limitations. Selective LEEP improves the accuracy rate of diagnosis.Conclusion:1. The cervical appearance (smooth or erosion) had no correlation with the grade of cervical lesions.2.The biopsy pathology results of mild abnormality of the cervical cytological examination were of wide range. cervical precancerous lesions and invasive carcinoma had a higher incidence in group ASC-H.3.A few atypical cells found might be regarded as early-warning of high-grade CIN or cervical cancer, and should be emphasized.4. The negative predictive value of HR-HPV was high, its detection rates increased with cervical lesion grades. HPV DNA test was an effective distributary measure to mild abnormality.5. colposcopy had the possibility of over-diagnosis and under-diagnosis.6. LEEP could make up for the deficiency of colposcopy diagnosis, and was the ideal way for treatment of cervical precancerous lesions.