| Background:Cervical cancer is one of the most common female mailignant tumor of the reproductive system worldwide in the recent years,which is also the only malignant tumor in women that can be prevented and intervened in advance.At present,a great number of developed countries have adopted HPV vaccine for primary prevention and achieved significant achievements,which has effectively reduced the incidence and mortality of cervical cancer.However,developing countries with underdeveloped economic and healthcare services are scarcely ever able to widely use primary prevention measures.China,as the largest developing country,still mainly adopts secondary prevention measures for cervical cancer,that is,screening women who are at high risks of being attacked by cervical cancer,and then conducting further examination,diagnosis,and treatment with those who receive abnormal results to block the lesions from precancerous or early cancers.Actually,it usually takes about 6-10 years to develop cervical intraepithelial lesions into cervical malignant tumors,which will be faster and more likely for high-grade cervical intraepithelial lesions.Therefore,it has become hotspots for medical workers for research on how to find the cervical lesion in time and accurately.At the moment,the screening for cervical intraepithelial lesions mainly follows the three-step procedure:HPV and/or TCT examination,colposcopy and colposcopy-guided cervical biopsy.Cervical biopsy is considered as the gold standard for diagnosis of cervical lesions.However,in recent years,studies have found that under the influence of many factors including patient age,type of cervical transition zone,and lesion distribution,colposcopic biopsy hascontributed to a high proportion of missed diagnoses of high-grade intraepithelial lesions in the cervix,which is undoubtedly a great challenge.Meanwhile,LEEP has come into the sight of healthcare providers due to its high diagnostic accuracy,diagnostic significance,therapeutic significance,relatively small surgical damage,and simple operation.However,some researchers currently hold the view that LEEP surgery may cause overtreatment and cause more long-term complications,thus,the diagnostic value of LEEP surgery in high-grade cervical intraepithelial lesions is currently unclear.Objective:To clarify the diagnostic value of LEEP for cervical high-grade intraepithelial lesions,and to provide reference for timely and reasonable adoption of diagnostic LEEP application factors,so as to improve the detection rate of cervical high-grade intraepithelial lesions and block disease development in a timely manner.Methods:Collect and analyze the statistics and follow-up results of the patients who were treated in our colposcopy outpatient clinic with LEEP surgery from January 2017 to August 2019,including their related medical history and clinical information.The postoperative pathological results were retrospectively analyzed,in which 89 patients were diagnosed with low-grade cervical intraepithelial lesions and chronic cervicitisby colposcopic biopsy but were eventually diagnosed with high-grade cervical intraepithelial lesions by LEEP(including 50 patients who were operated diagnostic LEEP because of the highly suspected characteristic of high-grade cervical intraepithelial lesions and 39 patients who were accidentally discovered by therapeutic LEEP to alleviate the uncomfort caused by LSIL and chronic cervicitis)and 210 patients with low-grade cervical intraepithelial lesions and chronic cervicitis diagnosed by LEEP.The clinical data of 89 patients with pathological results supporting high-grade cervical intraepithelial lesions and 210 patients with pathological results supporting low-grade cervical intraepithelial lesions and chronic cervicitis were preliminarily compiled by EXCEL software.SPSS 26.0 software was used for statistical analysis.Measurement data were expressed as x±s,and count data were expressed as number of cases(n)and composition ratio(%).Statistical comparison of the results of colposcopy biopsy and LEEP pathology.Application ?2 test was performed on the patient's age,clinical manifestations,TCT results,HR-HPV results,16/18HPV infection,type of cervical transition zone,the number of biopsy specimens,the proportion of cervical lesions,and colposcopy images satisfaction,age of first sexual life<18 years,cumulative number of sexual partners? 3,smoking history,regular oral contraceptive history,history of vaginitis and maternal history.The related factors which may cause the missed diagnosis of high-grade cervical intraepithelial lesions was performed by univariate analysis.Results:1.299 patients were eventually included in the study whose preoperative diagnosis were all LSIL or chronic cervicitis.89 patients showed a pathological grade from low to high,and the rate of missed diagnosis was 29.77%.These included 5 patients with glandular epithelial lesions:4 with high-grade glandular intraepithelial neoplasia,and 1 with adenocarcinoma in situ.It is worth noting that none of the five patients underwent colposcopy preoperative biopsy found glandular intraepithelial neoplasia.The postoperative pathological results consisted of 84 patients with simple HSIL diagnosis,3 with HSIL combined with HG-CGIN,1 with AIS diagnosis,1 with simple HG-CGIN diagnosis,and 210 patients with LSIL or chronic cervicitis.Overall,the coincidence rate of colposcopy biopsy for low-grade cervical intraepithelial lesions was 70.23%.2.Patients whose postoperative diagnosis is high-grade cervical lesions aged 21-70 years,with an average age of 45.02±11.52,with a peak age distribution of 45-54 years,accounting for 31.46%.The final diagnosis of LSIL and chronic cervicitis group was 18-71 years old,with an average age of 42.73±9.345.The peak age distribution was 45-54 years old,a total of 78 people,accounting for 37.14%.The population and the two groups of patients were approximately normal distribution in all ages,and there was no significant difference in the average age distribution of the two groups of patients(P>0.05).3.A total of 89 patients with postoperative pathological type upgraded to high-grade lesions,with an average pregnancy rate of 2.38±0.96(pregnancy range from 0 to 4),and an average parity of 1.67±0.84(parity range from 0 to 4 times).Correspondingly,a total of 210 patients in the LSIL group had an average pregnancy rate of 2.29±1.17(pregnancy range of 0 to 4 times)and an average parity of 1.49±0.83(parity range of 0 to 4 times).According to the statistics,it has been found that the pregnancy and parity rate of the high-grade lesion missed diagnosis group is not significantly higher than that of the low-grade lesion group(P>0.05).4.Of the patients who were found to have missed diagnosis after LEEP,39 patients who initially underwent LEEP surgery due to low-grade cervical lesions had obvious clinical symptoms,including 7 patients with abnormal vaginal secretions,27 patients with contact bleeding,and 5 individuals with irregular vaginal bleeding,accounting for 7.87%,30.34%and 5.62%respectively.Meanwhile,further diagnosis of LEEP finally found 50 patients who were highly suspected of high-grade cervical intraepithelial lesions missed the diagnosis,including 32 patients with clinical symptoms.There were 10 persons with abnormal vaginal secretions(11.24%),14 persons with contact bleeding(15.73%),and 8 persons with irregular vaginal bleeding(8.99%).According to the Pearson chi-square test,compared with the non-missed group,the percentage of the patients with clinical symptoms was statistically different(P<0.000),that is,the proportion of patients with clinical manifestations in the missed diagnosis group was significantly higher than that in patients with low-grade cervical lesions.Differences in patients with abnormal vaginal secretions,contact bleeding and irregular vaginal bleeding are statistically significant,suggesting that when the corresponding clinical manifestations appear,it is highly suggestive of the risk of missed diagnosis of high-grade cervical intraepithelial lesions.5.Univariate analysis showed that age,menopause,vaginal contact bleeding,abnormal vaginal bleeding,abnormal vaginal secretions,HPV16/18 infection,cervical transformation zone type III,colposcopy satisfaction,smoking history,and multiple births were all associated with high-grade cervical intraepithelial lesions missed diagnosis(P<0.05).6.The incidence of postoperative complications of LEEP is only 2%,and there are women with normal pregnancy outcomes after surgery.Conclusions:1.LEEP has significant advantages as a diagnostic method for high-grade cervical intraepithelial lesions,which can obviously improve the accuracy of the diagnosis of high-grade cervical intraepithelial lesions and reduce the probability of missed diagnosis,especially for HG-CGIN and AIS which may occur in the cervical canal protruding.Besides,it can provide treatment at the same time as diagnosis,and there are fewer postoperative complications,which is worthy of popularization and application.2.16/18 HPV infection,type of cervical transformation zone(type III transformation zone),poor satisfaction with colposcopy images,and patient age(>50 years),menopause,clinical symptoms(contact bleeding,vaginal secretion abnormalities and irregular vaginal bleeding),smoking history,prolificacy history and other medical history factors are high-risk factors for missed diagnosis of high-grade cervical intraepithelial lesions.When the relative issues appear,it will be reasonable to broaden the range of application of LEEP moderately to avoid the missed diagnosis of high-gradecervical intraepithelial lesions. |
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