Analysis Of The Benefit Of Topical Estrogen In Postmenopausal Patients Undergoing Colposcopy

Objective To evaluate the effects of vaginal estrogen cream to the abnormal cervical cancer screening results secondary to atrophy and inflammation and the rate of satisfactory colposcopy in post-menopausal women.Methods 294 post-menopausal woman undergoing colposcopy for abnormal cervical screening results were enrolled from Janurary 2018 to July 2019.Randomly dividing them into two groups,The 147 study group patients were treated with Ovestin Vaginal cream once every night at a time of 0.5 g for three weeks.Before and after the use of estrogens,the variation of thin prep test results,the type of transformation zone?TZ?,the visibility of squamous columnar junction?SCJ?and whether adequate exposure were observed.We also compared the suspected diagnosis of colposcopy examination and the cervical biopsy or scratching results with the final pathological diagnosis to get the diagnostic coincidence rate.The detection rate for different grades of cervical lesions was also calculated different diagnostic patterns.Results 1.After the use of estrogens,The vaginal atrophy score and vaginal symptoms score descended,one from 6.85±2.11 to 3.43±1.55,and the other from 4.13±2.12 to1.26±1.77,with statistical significance(t_atrophy=2.75,t_sympotoms=2.23,P<0.05).The proportion of each layer vaginal cells changed with the increase of superficial cells from 9.43±7.61 to36.20±27.63 and intermediary cells from 34.30±26.43 to 55.33±25.27,and with the decrease of parabasal cells from 56.17±37.64 to 8.45±10.12,the difference was statistically significant(t_sup=13.40,t_int=10.13,t_par=14.74,P<0.05).2.All of the enrolled patients have abnormal thin prep test results before estrogen use,but 43 of these abnormal results changed into normal?NILM?after estrogen therapy and the number of ASCUS decreased from 65 to26.Compared with the final histopathological results,the accuracy of cytological prediction was improved from 23.13%?34/147?to 58.50%?86/147?,with statistical significance??²=38.07,P<0.05?.After estrogen use,the positive predictive value for LSIL by cytology increased from 61.90%to 83.67%,with statistical significance??²=5.52,P<0.05?.The positive predictive value for chronic cervicitis also increased to 79.07%.3.The cervical exposure rate increased from 36.73%?54/147?to76.87%?113/147?after estrogen treatment??²=48.25,P<0.05?.The type I and II of transformation zone?TZ?number increased from 8.16%?12/147?to 29.25%?43/147?,with statistical significance?Z=4.55,P<0.05?,and the visibility rate of squamous columnar junction?SCJ?increased from 30.61%?45/147?to 72.79%?107/147?,with statistical significance?Z=7.16,P<0.05?,as to we get more satisfactory colposcopy.The suspected diagnosis accuracy rate of colposcopy increased from 59.18%?87/147?to 78.23%?115/147?for study group??²=12.40,P<0.05?,compared with the control group64.63%??²=6.67,P<0.05?.The positive predictive value for chronic cervicitis by suspected diagnosis of colposcopy in the study group was higher than that before estrogen therapy,from 60.38%?32/53?to 83.05%?49/59?,with statistical significance??²=7.17,P<0.05?.The positive predictive value for LSIL elevated from 54.05%?40/74?to 73.33%?55/75?,with statistical significance??²=5.99,P<0.05?.4.Compared the histopathological results of cervical biopsy or scratching with the final pathological diagnosis,the coincidence rate for study group is 81.63%?120/147?,and 68.03%?100/147?for control group??²=7.22,P<0.05?.The positive predictive value for chronic cervicitis by cervical biopsy in the study group was higher than that in control group?78.67%VS 61.54%?,with statistical significance??²=5.34,P<0.05?.Conclusion 1.Topical application of estrogen before colposcopy in post-menopausal women can improve local vaginal microenvironment,achieve satisfactory colposcopy and inccrase the diagnosis accuracy of cervical lesions.Also,reduce the discomfort of examination and the cost of diagnosis and treatment.2.For thin prep test results presented as ASCUS or above,the application of estrogen helps to distinguish the atrophic cytological morphology in postmenopausal women.