The Impact And Analysis Of Different Types Of Cervical Transformation Zone In The Colposcopic Diagnosis Of Cervical Intraepithelial Neoplasia

Cervical cancer is one of the most common malignancies in women gynecological malignancies, and plays a forefront place in cancer incidence of female. Attributed to the cervical cytology screening, cervical cancer was used to be the most common cause of cancer death in female, is now the14th cause of cancer death from the mid-20th century in United States. According to World Health Organization statistics, the number of new cases of cervical cancer is above450,000every year, and more than one third of these new cases are diagnosed in China. Large number of epidemiological datas and laboratory studies have demonstrated that almost all cervical cancer cases (99%) were infected with genital HPV.It is a normal precess that squamous metaplasia in young women. But the process of metaplasia makes HPV replicate easier, which leading to a high rate of HPV infection in young women. HPV include high-risk and low-risk types, the development of cervical cancer are closely related to a persistent infection with high-risk HPV. The world recognized model of the development of cervical cancer is:high-risk HPV persistent infection-cervical intraepithelial neoplasia-cervical cancer.Combined with smoking, pregnancy and labors, oral contraceptives, immune suppression, precancerous lesions may progress to cervical cancer in about10years. This long period provides a good time condition to diagnose and treat the pre-cancerous(cervical intraepithelial neoplasia). Detect and diagnose and treat cervical intraepithelial neoplasia early can reduce the incidence and mortality of cervical cancer. Currently, the mainly process of diagnosis and treatment of cervical intraepithelial neoplasia are cervical cytology screening,further colposcopy,cervical biopsy or direct diagnostic conization if necessary, finally LEEP.Early intervention of precancerous lesions can prevent the development of cancer.A strong light was used to illuminate and enlange the cervix and lower genital tract10-40times to observe these invisible lesions in colposcopy. Colposcopy was first pioneered to screening cervical lesions by the German Hans Hinselmann in1925. At the beginning the1940s, Pap smear cytology techniques became popular, both of these screening methods were considered equivalent. Some years later, clinical staff gradually discovered that colposcopy and cytology has become as complementary methods to diagnose cervical intraepithelial neoplasia. Colposcopy play an important role in the discovery of cervical intraepithelial neoplasia (Cervical Intraepithelial Neoplasia, CIN) and early cervical cancer. Colposcopy results can directly affect the implementation of subsequent treatment of CIN. Because of the subjectivity in colposcopy image interpretation, the value of colposcopy for diagnosis of cervical intraepithelial neoplasia was questioned by more and more scholars in recent years. In fact, The influencing factors of the accuracy of colposcopy in diagnosis cervical intraepithelial neoplasia are multiple. These possible factors are age, motherhood, labor, the transformation zone type,et al. This article will study the datas of surgery patients who achived loop electrosurgical conization (Loop Eelectrosurgical Excision Procedure, LEEP) due to cervical intraepithelial neoplasia from January2009to August2013in the Guangdong General Hospital, which man analyse the impact of different types of cervical transformation zone in colposcopic diagnosis of cervical intraepithelial neoplasia and make a preliminary study of its impact factors.Research Methods1.1General information There are a total of1384patients who went to colposcopy clinics with abnormal cytology or high-risk HPV infection or had diagnosis with cervical intraepithelial neoplasia in other hospital and achieved a colposcopy and were diagnosed cervical intraepithelial neoplasia by cervical biopsy (or in other hospital) and got a LEEP (Loop Eelectrosurgical Excision Procedure) surgery finally from January2009to August2013in the Guangdong General Hospital. The following cases were excluded:previous cervical treatment history (including a history of frozen, microwave, laser therapy, cold knife cone biopsy, etc), pregnancy, the naked eye can see new neoplastic.Finally,there were a total of1156cases participated in this retrospective study. There were57patients with highly abnormal cytology and colposcopy unsatisfied,who got a directed LEEP surgery after informed consent, the remaining patients had a cervical colposcopic guided biopsy before surgery.1.2Inspection methods1.2.1Cervical Cytology Cervical liquid-based cytology (TCT) sampling machine preservation solution was used, If a junior pathologist read the TCT, one or more deputy chief physician pathology specialist doctors.will re-read the TCT. or a deputy chief physician pathology physician read the cervical cytology directly.TCT diagnostic criteria adopted the TBS (The Besthesda system) classification.1.2.2High-Risk HPV-DNA Detection The Hybrid Capture-2(HC-2) technology was adopted, using of the antibody capture chemiluminescent signal amplification and detection of signals, which can detect13types of high-risk HPV (16,18,31,33,35,39,45,51,52,56,58,59and68). results were quantificated to5groups;<lpg/ml;1-10pg/ml;10-100pg/ml;100-1000pg/ml;>1000pg/ml.1.2.3Colposcopy Shenzhen Goldway company SLC-2000colposcopy was adopted in this study. Deputy specialist doctors of our hospital conducted the colposcopy operations and record images of all cases. According to2011international federation of cervical pathology and colposcopy colposcopic terminology of the cervix,cervical transformation zone will be divided into three types:Ⅰ type:cervical transformation zone with varied range were entirely outside that can be full observed in vagina. Ⅱ type:Part of the transformation zone was located in the external-cervix and the part of the transformation zone located in the endocervical with varied range can be full observed in vagina. Ⅲ type:cervical transformation zone was located in the endocervical, which can not be observed completed. Doctors read the image according to the colposcopic terminology of the cervix.All cases were divided to two groups:high-grade lesions and low-grade lesions or normal results in colposcopy. Low-grade lesions:Grade1(minor):Fine mosaic; fine punctation; thin acetowhite epithelium; irregular, geographic border. High-grade lesions:Grade2(major):Sharp border; inner border sign; ridge sign; dense acetowhite epithelium; coarse mosaic; coarse punctuation; rapid appearance of acetowhitening; cuffed crypt (gland) openings.After making an initial diagnosis, we make colposcopy-guided biopsy in these suspicious lesions, including acetic acid white epithelium, mosaic,point-like blood vessels, abnormal blood vessels, white and dotted areas, and these other suspicious cervical lesions. patients with unsatisfactory colposcopy, and TCT suggested that a suspicious high-grade would get a direct diagnostic LEEP and an endocervical curettage,after informed.1.2.4LEEP All patients got a "cowboy hat" type LEEP surgery,and endocervical curettage. specimens labeled " External-cervix conization specimen " and " endocervical conization specimen "and " endocervical curettage specimen ".All biopsy specimens and LEEP surgery specimens would be diagnosed by deputy director of the pathologist.StatistisAll datas were analyzed with SPSS13.0statistical software. Disorderly count datas may get a χ2test, level datas may get a non-parametric test method.When P <0.05, the difference was statistically significant.Results1. TCT Results In all cases in this study,71cases TCT result were negative,182cases were ASCUS,131cases were ASC-H,12cases were AGC,182cases were LSIL.500cases were HSIL,21cases were suspicious cancer.20cases were SIL. There were37cases with no TCT results but with other test results. In these HSIL cases,255cases were in type Ⅰ cervical transformation zone, and145cases were type Ⅱ and others were in type Ⅲwhich were consistent with the final pathological diagnosis with201,113,73cases, respectively, the rate of them were78.82%,77.93%,73.00%, respectively.χ2=1.426, P=0.49, P>0.05. The difference was unsignificant.2. HPV DNA Results For all cases,<1pg/ml:44cases;1-10pg/ml:101cases;10-100pg/ml:208cases;100-1000pg/ml:390cases;>1000pg/ml:190cases, no test results were78cases,145cases were positive in qualitative detection of high-risk HPV,whose results come from other hospital.3. Colposcopy Results The average age of all patients of the study was38.3years old, the average gravidity of them was2.9, the average parity of them was1.5.The type Ⅰ cervical transformation zone were621cases, The average age of them was35.7years old, the average gravidity of them was2.8, the average parity of them was1.4. type Ⅱ cervical transformation zone were335cases, The average age of them was39.2years old, the average gravidity of them was3.0, the average parity of them was1.5.and cervical transformation zone type Ⅲ were200cases, The average age of them was44.3years old, the average gravidity of them was3.2, the average parity of them was1.6. All cases were divided to two groups:high-grade lesions and low-grade lesions or normal results in colposcopy. In the group with high-grade lesions in colposcopic diagnosis,489cases were cervical transformation zone type1,266cases were type Ⅱ and90cases were type Ⅲ, In the group with low-grade lesions or normal in colposcopic diagnosis,132cases were cervical transformation zone type1,69cases were type Ⅱ and110cases were type Ⅲ.4. Histopathologic Findings The number of patients achived LSIL and normal as colposcopy-guided biopsy were100cases,999cases of high-grade lesions,57cases of non-pathological. The number of patients achived low-grade lesions and normal as LEEP pathological diagnosis were248cases,826lesions with high-grade lesions and82cases were cancer (including microcarcinoma), in which three cases of patients were with no colposcopy-guided biopsy results.Finally,1,020cases were diagnosed with high-grade lesions histodiagnosis.5. Comparing colposcopic diagnosis、colposcopy biopsy diagnosis and LEEP surgery pathology results of patients in different cervical transformation zone. 5.1The compliance rate of colposcopic diagnosis and the final pathological diagnosis was different in different types of cervical transformation zone. In patients with type Ⅰ transformation zone, the compliance rate was72.46%(450/621), in patients with type Ⅱ, the compliance rate was71.3%(239/335), in patients with type Ⅲ, the compliance rate was43.5%(87/200). Comparison these compliance rates,χ2=61.310, P=0.000, P<0.05, the difference was statistically significant,χ2(Ⅰ、 Ⅱ)=0.136, P>0.0125;χ(Ⅰ、Ⅲ)=56.090, P<0.0125; χ2(Ⅱ、Ⅲ)=40.785, P<0.0125; the difference was unsignificant in Ⅰ, Ⅱ types, the difference were significant in Ⅰ,Ⅲtypes and Ⅱ,Ⅲ types.5.2When colposcopic diagnosis were high-grade lesions, the compliance rate of histopathological diagnosis in colposcopy-guided biopsy and LEEP were75.66%,70.67%,61.11%in type Ⅰ, Ⅱ,Ⅲ,respectively.χ2=8.763, P<0.05. when colposcopic diagnosis were low-grade lesions or normal, the compliance rate were65.15%,52.17%,47.17%,χ2=6.278, P<0.05, the difference was significant.5.3When the colposcopy diagnosis were different, the compliance rate of histopathological diagnosis in colposcopy-guided biopsy and LEEP were different in the same TZ. In patients with type Ⅰ, the compliance rate were75.66%,65.15%, respectively,χ2=5.888, P<0.05. In patients with type Ⅱ, the compliance rate were70.67%,52.17%, respectively,χ2=8.446, P<0.05, the difference were significant.But in type Ⅲ, the compliance rate were61.11%,47.17%, respectively.χ2=2.630,P>0.05. the difference was unsignificant.5.4Finally,1,020cases were diagnosed with high-grade lesions histodiagnosis. The rate of cervical canal samples with positive histodiagnosis in type Ⅰ, Ⅱ, Ⅲ were34.8%,41.9%,50.6%, respectively.χ2=14.439, P=0.001, P<0.05, the difference between these groups were statistically significant, χ2(Ⅰ、Ⅱ)=4.186, P>0.0125; χ2(Ⅱ、Ⅲ)=3.246, P>0.0125;χ2(Ⅰ、Ⅲ)=13.518, P<0.0125; the difference were unsignificant in Ⅰ, Ⅱ types and Ⅱ, Ⅲ types, the difference was significant in Ⅰ,Ⅲtypes Conclusions1.1The accuracy of colposcopy diagnosis of cervical intraepithelial neoplasia were different in different types of cervical transformation zone. Which in type Ⅰ,Ⅱ were higher than type Ⅲ.1.2The clinical effect of colposcopy-guided biopsy in cervical transformation zone in type Ⅰ, Ⅱ were higher than in type Ⅲ.1.3When we inspect patients with cervical transformation zone of type Ⅱ, Ⅲ in colposcopy, we should inspect the endocervical carefully, combining the TCT results.1.4The type of Cervical transformation zone may be the major factor that affect colposcopic diagnosis of cervical intraepithelial neoplasia.