| Objective: Research on the "three-step" diagnostic procedure for cervical lesions will help develop cervical cancer screening strategies that are more suitable for the Chinese population.Method: The data of 2421 women who underwent cervical screening in the gynecology clinic of Wuhan Central Hospital were analyzed retrospectively.Firstly,the pathologic diagnosis was compared with thin prep liquid-based cytological test(TCT),human papillomavirus(HPV)typing and vaginoscopy,respectively.Secondly,the detection ability of three different screening(TCT or HPV-DNA typing alone,TCT and HPV-DNA typing combined screening)were compared.Thirdly,the pieces of high-grade cervical lesions diagnosed by colposcopy were compared,to find the location where the cervical surface is most prone to pathological changes.Finally,judge the coincidence according to the pathologic diagnosis after cervical coning and biopsy guided by vaginoscopy.Result: Among the 2421 patients,there were 1464 cases of inflammation,428 cases of low-grade squamous intraepithelial lesions(LSIL),444 cases of high-grade squamous intraepithelial lesions(HSIL)and 85 cases of cervical cancer.Among the1768 cases of negative for intraepithelial lesion or malignancy(NILM)by TCT,184 cases were diagnosed as ≥HSIL.Among the 440 people of atypical squamous cells of undetermined significance(ASCUS)by TCT,≥HSIL was confirmed in 208 people(47.27%).Among the 183 people of LSIL by TCT,≥HSIL was confirmed in 108people(59.02%).Among the 30 people of ≥HSIL by TCT,≥HSIL was confirmed in29 people(96.67%). Among the 2421 patients,1573 cases were positive for high-risk HPV.The distribution characteristics of HPV DNA type were ranked according to the top six infection rate as HPV52,16,58,18,51,39.Among the 1892 cases of ≤LSIL by histopathology,1070 cases were infected with HPV(56.55%).Among the 529 cases of ≥HSIL by histopathology,503 cases were infected with HPV(95.09%). Among 761 cases with pathological results ≥LSIL,the distribution characteristics of HPV DNA type were ranked according to the top six infection rate as HPV16,52,58,18,33,51.The single infection rates of the three groups(LSIL,HSIL,cervical cancer)were 54.26%,62.23%,84.15%,and the multiple infection rates were 45.74%,37.77%,15.85%,respectively. Among the three groups of screening,TCT has the highest specificity of 83.72%(95%CI: 81.96%,85.34%),HPV has the highest sensitivity of 94.90%(95%CI:92.57%,96.55%),and the AUC of TCT and HPV-DNA typing combined screening has the highest value of 0.810(95%CI: 0.788,0.831). Among the 2421 colposcopies,1695 were tally with histopathology(70.01%).29.99% of colposcopy diagnoses were not tally with pathological results,including16.85% overdiagnosis and 13.14% underdiagnosis.The sensitivity,underdiagnosis rate and coincidence rate of colposcopy examination in type Ⅰ transformation area were 84.56%,15.44%,87.99%.The sensitivity,underdiagnosis rate and accuracy of colposcopy examination in type Ⅱ transformation area were 77.50%,22.50%,85.80%.The sensitivity,underdiagnosis rate and accuracy of colposcopy examination in typeⅢ transformation area were 48.67%,51.33%,73.68%. Among HSIL confirmed in 444 people by biopsy guided by vaginoscopy,877 pieces of cervical tissues were diagnosed as HSIL.199 pieces came from the first quadrant,accounting for 22.69%.232 pieces came from the second quadrant,accounting for 26.45%.239 pieces came from the third quadrant,accounting for27.25%.207 pieces came from the fourth quadrant,accounting for 23.61%.406 pieces were located in the anterior lip of the cervix,accounting for 46.29%.There were 471 pieces(53.71%)located in the posterior lip of the cervix.431(49.14%)were located on the right side of the cervix.There are 446 in the left cervix,accounting for50.86%. Among the 252 conization of cervix,203 were tally with histopathology of colposcopy biopsy(80.56%).Among the 9 people,4 people of biopsy as HSIL were in accord with conical pathologic diagnosis,with agreement rate of 44.44%.Among the 40 people,27 people of biopsy as HSIL were in accord with conical pathologic diagnosis,with agreement rate of 67.50%.Among the 197 people,167 people of biopsy as HSIL were in accord with conical pathologic diagnosis,with agreement rate of 84.77%.Among the 6 people,5 people of biopsy as HSIL were in accord with conical pathologic diagnosis,with agreement rate of 83.33%.Conclusion: 1.The higher the TCT result grade,the higher the probability of diagnosis of HSIL.2.The infection rate of HPV and single infection rate elevated with the more severe the cervical disease.And the multiple infection rate of HPV decreased with the increase of cervical lesion grade.3.Compared with the diagnostic value of three different screening methods,combined screening has better diagnostic efficacy for ≥HSIL than single detection.4.Vaginoscopy has a certain value in the diagnosis of cervical lesions.And we should pay attention to under-diagnosis in vaginoscopy.The agreement rate of vaginoscopy in the diagnosis of ≥HSIL was significantly lower in Ⅲ type transformation area than in Ⅰ type.5.HSIL are easier to located in the posterior lip of the cervix.6.The pathologic diagnosis of biopsy guided by vaginoscopy had a high agreement rate with the results after cone resection. |
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