| Background and ObjectiveCervical intraepithelial neoplasia(CIN)is closely related to cervical cancer.In2012,the College of American Pathologists(CAP)and the American Society for Colposcopy and Cervical Pathology(ASCCP)recommended the use of squamous intraepithelial lesions(SIL)to rename the lesions associated with human papillomavirus(HPV)infection in the lower genital tract including the cervix and classified them into low-grade squamous intraepithelial lesions(LSIL)and high-grade squamous intraepithelial lesions(HSIL).HSIL has a higher risk of progression to invasive cancer of cervical and is considered as a precancerous lesion,which needs to be treated in time.LSIL is considered to be the transient expression of HPV infection,most of which can naturally regress,the risk of cancerization is low,and there is still controversy about whether the treatment is needed.The current guidelines indicate that if the cytology results is LSIL or less,only follow-up observation be performed.If the lesion persists for more than 2 years or the lesion progresses during follow-up,treatment may be considered.If the cytology is HSIL or atypical glandular cells(AGC),colposcopy or diagnostic conization can be further performed todetermine the nature of the lesion.In a word,due to the high regression rate of LSIL,the current management of LSIL is becoming more and more conservative,so as to avoid unnecessary economic burden and great mental stress caused to patients by excessive treatment.However,it should be noted that some patients with LSIL have the possibility of progression of the lesions during follow-up.The reasons may be as follows: first,insufficient examination and missed diagnosis of existing high-grade lesions;second,some high-risk factors existed in patients themselves prolong the duration of the lesion and raise the rate of the disease progression.The main purpose of this study is to analyze the factors related to the pathological progression of patients with LSIL after cervical loop electrosurgical procedure(LEEP),to predict the risk factors for the progression of LSIL lesions,and to provide some references for clinicians to comprehensively assess LSIL patients and make rational individualized treatment plans.Materials and MethodsData of 380 patients who underwent LEEP surgery for LSIL in the first affiliated hospital of zhengzhou university from September 2016 to February 2018 were collected.Organize related data,including ThinPrep Cytology Test(TCT)results,human papillomavirus(HPV)testing results,cervical transformation zone type,endocervical curettage(ECC)results,the range of lesions involving,contact bleeding,age,age of first sexual experience,gravidity and parity history,menopausal status,disease duration and pathological results after LEEP,compare the pathological changes before and after LEEP surgery,and analyze the influencing factors of postoperative pathological upgrading.Single factor analysis was performed on each factor,and then the factors with statistically significant differences were included in the Logistic regression model for multivariate analysis.? = 0.05 for the test standards.Surgical indications for LEEP: 1.Cytology is HSIL or AGC.2.LSIL lesions persist for more than 2 years.3.Symptoms of vaginal contact bleeding are obvious after excluding other causes.In this study,the histological diagnosis of LSIL refers tocervical intraepithelial neoplasia grade one(CINI),excluding condyloma,hollowing out cell-like changes,etc.Results1.A total of 380 patients,118 cases(31.1%)had postoperative pathological upgrading.Single factor analysis was performed on factors including TCT results,HPV testing results,cervical transformation zone type,ECC results,the range of lesions involving,contact bleeding,age,age of first sexual experience,gravidity and parity history,menopausal status and disease duration,and the results suggested that the factors with statistically significant differences between the postoperative pathologically upgraded group and the non-upgraded group were as follows:1.1 Age There were 309 cases who were more than or equal to 40 years old,103 cases(33.3%)showed postoperative pathological upgrading,71 cases were less than 40 years old,15 cases(21.1%)showed postoperative pathological upgrading,there was a statistically significant difference in age(P < 0.05).1.2 TCT 50 cases with cytology suggesting ASC-H/HSIL/AGC,35 cases with postoperative pathological upgrading.And 190 cases with ASC-US or LSIL,50 cases with upgrading.And 140 cases with negative cytology,33 cases with upgrading.There was a statistically significant difference between the three groups(P < 0.05).1.3 HPV 354 cases with HPV positive.There were 164 cases of HPV16/18 positive,75 cases of postoperative pathological upgrading.190 cases of other high-risk HPV positive,42 cases of upgrading.26 cases of HPV-negative,1 case of postoperative pathological upgrading.The difference of HPV infection between upgraded group and non-upgraded group was statistically significant.The postoperative pathological upgrading rate of HPV16/18 positive patients was higher than that of other high-risk positive patients,and the difference was statistically significant(P < 0.05).1.4 Cervical transformation zone type There were 276 cases of type I and type II transformation zones,77 cases were upgrading,104 cases were type III transformation zone,and 41 cases were upgrading.The two groups had an upgradingrate of 27.9% and 39.4%,respectively.The difference was statistically significant(P < 0.05).1.5 ECC 252 cases underwent colposcopic cervical biopsy combined with ECC,postoperative pathological upgrading in 81 cases(32.1%).128 cases without ECC,and postoperative pathological upgrading in 37 cases(28.9%).There was no significant difference between the two groups(P > 0.05).Of the 252 patients with ECC,111 were positive,45 were upgrading,141 were negative,36 were upgrading.The difference between the two groups was statistically significant(P < 0.05).1.6 the range of lesions involving The involvement range was indicated by the lesion involvement point number.165 cases with the lesion involvement point number were less than 2,61 cases with the upgrading(37.0%),215 cases with the involvement point number were greater than or equal to 2,57 cases with the upgrading(26.5%).The difference between the two groups was statistically significant(P < 0.05).2.Multivariate logistic regression analysis of these factors revealed that TCT results,HPV results and ECC results were independent risk factors for predicting postoperative pathological upgrading in LSIL patients(P < 0.05),Odds Ratios(OR)value 10.725?25.580 and 1.087,respectively;however,age,cervical conversion zone type and the range of lesions involving were not(P > 0.05).Conclusion1.TCT results,HPV results,and ECC pathology are independent risk factors for predicting postoperative pathological upgrading in patients with LSIL;TCT suggested ASC-H/HSIL/AGC,HPV16/18 positive and ECC positive were significantly associated with postoperative pathological progression.2.Age more than or equal to 40 years old,type III cervical transformation zone and small range of lesion involving are associated with postoperative pathological progression;however,age,cervical transformation zone type and the range of lesions involving are not independent risk factors for predicting postoperative pathological upgrading in LSIL patients.. |
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