The Diagnostic Value Of Colposcopy In Cervical Lesions

Background : Both the incidence and mortality of cervical cancer are high in the worldwide.The onset age of cervical cancer promotes younger staff.Cervical cancer affects the physical and mental health of women seriously.It is the only malignant tumor with clear cause.The key point of reducing the incidence and mortality is the screening of cervical cancer at an early stage,especially the cervical intraepithelial neoplasia(CIN).Colposcopy is one of the important steps in clinical screening of CIN and early cervical cancer.The result of colposcopy affects patients' diagnosis and treatment directly.Colposcopy is widely used in the screening of cervical cancer.But in the existing reports,the diagnostic value of colposcopy is not consistent.Objective:To explore the diagnostic value of colposcopy and evaluate its role in the diagnosis and treatment of cervical lesions.Methods: We retrospectively analyzed the clinical data of 536 patients who were treated in the Laoshan hospital of the Hospital Affiliated of Qingdao University from Sep.2015 to Oct.2016.These patients had all undergone colposcopy and multiple punch biopsies.According to the results of colposcopy images and biopsy pathology,the patients underwent cervical loop electrosurgical excision procedure(LEEP),cervical conization surgery or hysterectomy.And the general features,colposcopy image features,cervical biopsy pathological data and the final pathological data index were analyzed statistically.Results: In this study,the age of 536 patients ranges from 19 to 75 years old.The mean age of the patients was 32.9 ±3.4 years old.The mean gravidity of them was 2.8± 0.4,and the mean parity of them was 1.7±0.3.The final pathological diagnosis as diagnostic criteria was made by the higher pathological results of cervical biopsy and postoperation.Of the 536 cases of patients,364 cases were diagnosed high-grade squamous intraepithelial lession(HSIL)or worse with colposcopy images,172 cases were diagnosed low-grade squamous intraepithelial lession(LSIL)or lighter.The total coincidence rate of the diagnosis of the colposcopy image and final pathology was72.20%(387/536).Excessive diagnosed occurred in 111 cases(20.71%).Under diagnosed occurred in 38 cases(7.09%).When the diagnosis of the colposcopy image was LSIL or lighter,the coincidence rate with final pathological was 35.47%(61/172),and when the diagnosis of the colposcopy image was HSIL or worse,the coincidence rate was 89.56%(326/364).The coincidence rates of the diagnosis of the colposcopy image and final pathology were 78.73%,71.52% and 57.27%,respectively,in patients with type I,II and III transformation zone(X~2(I,II)=2.84 P?0.05,X~2(II,III)=4.30 P?0.05 and X~2(I,III)=18.01 P ? 0.05).The number of the patients who were diagnosed high-grade lesions with cervical biopsy was 397,and the number of the patients who were diagnosed low-grade lesions or lighter was 139.There was a correlation in histological findings between cervical biopsy and final pathology in 485 cases(90.49%),including 51 cases(9.52%)who were underdiagnosed.When the diagnosis of the cervical biopsy pathology were HSIL,the coincidence rate with final pathological was 96.98%(385/397),and when the diagnosis were LSIL or lighter,the coincidence rate was 71.94%(100/139).The coincidence rates of the diagnosis of the cervical biopsy pathology and final pathology were 94.03%,91.14% and 80.91%,respectively,in patients with type I,II and III transformation zone(X~2(I,II)=1.27 P?0.05,X~2(I,III)=15.20 P?0.05,X~2(II,III)=5.98P?0.05).Conclusion:(1)Both the colposcopy image and cervical biopsy pathology have high coincidence rate with the final pathology.Colposcopy has high diagnostic value in screening cervical lesions in colposcopy image and directing cervical biopsy.At the same time,we should pay attention to under-diagnosis in colposcopy image.(2)The coincidence rates were different in patients with different types of cervical transformation zone,which were higher in type I and type II than that in type III.While there was no significant statistical difference between type I and type II.(3)The diagnostic coincidence rate of colposcopy for high-grade cervical lesions was higher than that of low-grade lesions.