Analysis Of The Clinical Characteristics Of Cervical Intraepithelial Neoplasia And Cervical Cancer After Menopause

Background Cervical cancer(CC)is the fourth most common cause of cancer-related death in women,Cervical intraepithelial neoplasia(CIN)is a precancerous lesion of CC.Generally,it takes about 20 to 30 years for CIN to develop into CC,during which time many interventions can be implemented to reduce the morbidity and mortality of CC.In recent years,with the diversification of CC screening methods and the constant updating of screening guidelines,the morbidity and mortality of CC in the world has gradually declined,but it is on the rise in developing countries.Poor awareness of post-menopausal women's CC screening and its own particularity may cause them to miss the best time for prevention and treatment.Objective To discuss(1)the main reason for female patients at different physiological stages in this region to participate in cervical disease screening;(2)The clinical characteristics of postmenopausal CIN and CC patients,and compare the differences and similarities between them and premenopausal CIN and CC patients;(3)distribution of results of thin-cytologic test(TCT)in female patients with different physiological stages;(4)The relationship between the positive rate of TCT examination results and the pathological grade of cervical biopsy.Method A total of 413 patients with CIN and CC admitted to the department of obstetrics and gynecology of chaohu hospital affiliated to anhui medical university from December 2010 to August 2017 were collected.The pathological grade of all patientswas confirmed by colposcopy cervical biopsy.The general conditions(age distribution),chief complaints(normal physical examination,abnormal symptoms),clinical symptoms(abnormal leucorrhea,contact vaginal bleeding,irregular vaginal bleeding)and TCT examination results of enrolled patients were retrospectively analyzed.According to whether the patients were menopausal,they were divided into the menopausal group and the non-menopausal group,with 104 and 309 cases respectively.The results were analyzed to understand the characteristics of clinical symptoms and distribution of TCT results in different groups of patients.Results 1.In the menopausal group and the non-menopausal group,there were no obvious symptoms in the chief complaint,and the majority of cervical lesions were found by normal physical examination(53.8% and 68.9%,respectively),and the difference between the two groups was statistically significant(2=7.798,P=0.005).2.The clinical characteristics of the menopausal group were mainly irregular vaginal bleeding,which was significantly higher than that of the non-menopausal group(35.6%vs.12.6%),and the difference was statistically significant(2=27.307,P<0.001);The proportion of contact vaginal bleeding was significantly lower than that of the non-menopausal group(2.9% vs.13.3%),and the difference was statistically significant(2=8.814,P=0.003);The proportion of leucorrhea was higher than that of the non-menopausal group(7.7% vs.5.2%),but the difference was not statistically significant(2=0.899,P=0.343).3.Postmenopausal group,TCT examination for no malignant cells or epithelial cells(not intraepithelial lesion or malignancy,NILM)25 cases,not clear diagnosis significance of atypical squamous cells(atypical squamous cells of undetermined signification,ASC-US)14 cases,Atypical squamous cells-not except height of intraepithelial lesion(atypical squamous cells-always exclude HSIL,ASC-H)27cases,low-grade squamous intraepithelial neoplasia(low grade squamous intraepitheliallesion,LSIL)9 cases,highly squamous intraepithelial neoplasia(high grade squamous intraepithelial lesion,HSIL)29 cases,There were 76 cases,50 cases,51 cases,55 cases and 77 cases in the pre-menopausal group.The TCT results of the two groups showed that the HSIL positive rate was relatively low,27.9%(29/104)and 24.9%(77/309),respectively.The difference between the two groups was not statistically significant(2=8.532,P=0.074).4.In all populations,TCT examination results compared with cervical tissue pathology biopsy results found that with the increase of cervical tissue pathology biopsy level,TCT examination positive rate gradually enhanced,and CIN 1 group compared with CIN 2 group difference was statistically significant(chi-square = 19.525,P = 0.001),CIN compared with CIN 3 groups similar between the 2 groups was statistically significant(chi-square = 40.226,P < 0.001),CIN 3 groups there was no statistically significant difference compared with CC group(chi-square = 3.545,P = 0.471).Conclusion Compared with the non-menopausal group,the menopausal group had significantly more patients with irregular vaginal bleeding as the main reason for treatment,but the physical examination found cervical lesions as the main reason for the treatment.The proportion of patients with bleeding as the main reason for treatment is significantly less than that in the non-menopausal group,suggesting that asymptomatic people after menopause are rare.In the future,women in the region,especially post-menopausal women,should be strengthened to raise awareness of regular cervical lesion screening.The results of TCT tests in both groups showed that the HSIL positive rate was low,suggesting that a combination of multiple screening methods,such as HPV testing,would reduce the rate of missed diagnosis in high-risk groups.