A Prospective Study On The Role Of Cervical Random Biopsy In Risk-based Colposcopy

ObjectiveInvestigate the role of the cervical random biopsy in the Risk-Based colposcopy examination.Methods201 cases of women with the abnormal screening results in Tianjin first central hospital were all performed with the colposcopy examination and were taken directed biopsies and random biopsy from September 2017 to December 2018.Compare the consistency between the pathology of the directed biopsies and random biopsy aim to analyse the necessity of the random biopsy during the colposcopy examination.The pathological results were divided into?CIN I and?CIN II,the pathological results of?CIN I included cervicitis,HPV infection and CIN I,the pathological results of?CIN II included CIN II,CIN II-III,CIN III and invasive cervical cancer.If the pathological results of the directed biopsy and the random biopsy both are?CIN I or?CIN II,then the result is interconsistency.Results1.53 cases(26.36%)with HSIL were diagnosed by colposcopy biopsy.The diagnostic rates of HSIL in low-risk group,intermediate risk group and high-risk group were 8.82%,27.27%and 73.91%,respectively.The diagnostic rate of HSIL in the three groups was significantly different(?~2=37.606,P=0.000).The rate of HSIL in the high-risk group was higher than that in the intermediate risk group and low-risk group(P<0.05).The rate of HSIL in the intermediate risk group was higher than that in the low-risk group(P<0.05).Among the 53 patients whose pathological diagnosis was?CIN II,the rate of missed diagnosis by directed biopsy was 5.66%.2.There were 68 patients in the low risk group and the consistency between the directed biopsies and random biopsy was well(Kappa=0.477,P=0.000).Among 6cases(8.82%)with?CIN II confirmed by directed biopsy,only 2 cases were diagnosed?CIN II by random biopsy.3.There were 110 patients in the intermediate risk group and the consistency between the directed biopsies and random biopsy was poor(Kappa=0.195,P=0.010).Among 30 cases(27.27%)with?CIN II,3 cases were diagnosed only by random biopsy,the rate of missed diagnosis by directed biopsy was 10.00%.4.There were 23 patients in the high risk group and the consistency between the directed biopsies and random biopsy was poor(Kappa=0.138,P=0.191).Among 17cases(73.91%)with?CIN II confirmed by directed biopsy,only 4 cases were diagnosed?CIN II by random biopsy.5.There were 166 patients which colposcopy impressions were LSIL,the coincidence rate between the colposcopy impression and pathological results was80.72%.There were 35 patients which colposcopy impressions were HSIL+,the coincidence rate between the colposcopy impression and pathological results was60.00%.Conclusion1.Risk-Based Colposcopy Practice can improve the detection rate of high-grade cervical lesions;2.Random biopsy under colposcopy has no the role of improvement HSIL diagnosis in the low risk group;in the intermediate risk group and high risk group,random biopsy can reduce missed diagnosis and determining the lesion range,therefore,reduce the risk of positive margins after cervical conization.3.The accuracy of colposcopy examination is influenced by the level and experience of the colposcopist.In order to standardize colposcopy examination,the training of colposcopist should be strengthened.