Screening,Diagnosis And Depth Analysis Of Cervical High-grade Lesions Complicated With Involved Glands

Objective:It provides a basis for lesion depth for patients with type I transformation zone and different grades of HSIL with involved glands with fertility needs,and provides a reference for clinicians to formulate treatment plans and coning depth for patients with different grades of HSIL.Reduces the risk of adverse pregnancy outcomes due to cervical coning.Patients and Methods:A total of 125 patients who underwent colposcopy examination of type I transformation zone in the cervical lesions center of a hospital in Jinan from June 2018 to June 2020 and were confirmed by cervical biopsy pathology as high-grade cervical lesions with gland involvement were collected.Among them,68 cases in the CINII group and 57 cases in the CINⅢ group were selected as the subjects of this study.By comparing the colposcope examination type I translate the high level cervical lesions(CINII and CINIII)involving glands patients in the age distribution,TCT detection rate and HPV infection rate and missed diagnosis,both under colposcope Reid score difference,and by measuring the HE sliced the lesions involving the deepest glands and transformation of the cervical squamous epithelium on the surface of the distance difference,the amount of involvement quadrant to compare the differences of the two groups.The age,maternal order,TCT report results,HPV infection type,Reid score,involvement quadrant and other indicators of the subjects were collected to establish a database.Meanwhile,standard deviation,constituent ratio,incidence and other indexes were used to describe the above variables2 Test the difference test of the above variables.Results:1、Using TCT≥ASCUS as the detection standard in this study,the detection rate of TCT in the CINⅢ group was 82.35%(56/68),and the rate of missed diagnosis was 17.65%(12/68).The detection rate of TCT in the CINⅢ group was 96.49%(55/57),and the rate of missed diagnosis was 3.51%(2/57).Statistical difference analysis showed that there was significant difference between the two groups(χ2=6.232,P=0.013).2、CINII group in the study of HPV positive number of 64 people,accounted for 94.12%(64/68),the missed diagnosis rate was 5.88%(4/68),including simple infection accounted for 51.47%(35/68),mixed infection accounted for 42.65%(29/68),of 55 people group CINIII HPV positive number,accounted for 96.49%(55/57),the missed diagnosis rate was 3.51%(2/57),including simple infection accounted for 71.93%(41/57),mixed infection accounted for 24.56%(14/57).Statistical difference analysis showed that there was significant difference between the two groups(χ22=5.847,P=0.041).The infection rates of HPV16 were 54.41%(37/68),HPV52 20.59%(14/68),and HPV58 14.71%(10/68)in the CINII group.The top 3 infections in the CINⅢ group were HPV16 54.39%(31/57),HPV58 19.30%(11/57),and HPV52 10.53%(6/57).3、In this study,a positive cutoff value was defined as Reid score≥3.The sensitivity was 80.88%(55/68)in the CINII group and 96.50%(55/57)in the CINⅢ group with Reid score≥3.Statistical difference analysis showed that there was significant difference between the two groups(χ22=7.154,P=0.007),the average Reid score in the CINⅡ group was 4.68±2.25 points,and the average Reid score in the CINⅢ group was 6.25±1.65 points.4、The measured data in the study were corrected(/0.847),and the lesion depth in the CINIII group was between 0.216 and 2.361mm,with a mean of 0.674±0.409 mm,and that in the CINIII group was between 0.865 and 3.541mm,with a mean of 1.736±0.583 mm.The statistical results showed that the lesion depth in the CINIII group was deeper than that in the CINⅢ group,and the difference was statistically significant(t=11.924,P=0.001).98.53%(67/68)of the CINII group had lesion depth≤2mm.In the CINⅢ group,77.19%(44/57)had a lesion depth ≤2mm,and 98.25%(56/57)had a lesion depth ≤3mm.The mean total lesion depth in the study was 1.15±0.73mm.5、In this study,the incidence of one quadrant and two quadrants involved in CINII group was higher(27.94%(19/68)and 45.59%(31/68),respectively);The incidence of two quadrants and three quadrants were 49.12%(28/57)and 26.32%(15/57)in CINⅢ group,respectively.Statistical difference analysis showed that there was significant difference between the two groups(χ2=6.871,P=0.047).6、In the study,65 people were mainly aged between 31 and 40 years old,accounting for 52%(65/125).Among them,47 people were mainly aged between 21 and 40 years old in the CIII group,accounting for 69.12%(47/68),and 46 people were mainly aged between 31 and 50 years old in the CIII group,accounting for 80.7%(46/57).In the study,the number of pregnancies<2(28 patients,22.4%)was much lower than the number of pregnancies≥2(97 patients,77.6),suggesting that≥2 pregnancies may be a risk factor for cervical lesions.Conclusion:1.In the secondary prevention of cervical cancer,clinicians need to strengthen clinical screening for women between 31 and 40 years old,especially for women with more than 2 pregnancies.2.For women with active screening awareness,from the perspective of maximizing the risk of individual missed diagnosis,TCT+HPV combined screening was recommended.For patients with TCT screening results≥ASCUS,special attention should be paid to women with single subtype infection of HPV16,52 and 58.3.Colposcopy Reid score is helpful to distinguish between different grades of high-grade lesions.4.For clinical cases with cervical biopsy of CINII or CINⅡ-Ⅲ combined with gland involvement,type I transformation zone under colposcopy,Reid score≥5,involvement quadrant within 2 quadrants,no birth or high demand for birth can be considered to appropriately reduce the depth of coning considering the lesion depth of 2-3mm after full communication.It is suggested that small coning surgery beyond the lesion of 3mm is feasible.