| Objective: By comparing the cytohistological discrepancies between Liquid-based cytology(LCT)and colposcopy biopsy,and analyzing the influence of related factors on the differency,so as to provide reference for clinical reasonable referral of colposcopy and avoid missed diagnosis.Methods: A total of 2158 patients underwent LCT and colposcopy biopsy were collected from January 2018 to July 2019 in Affiliated Hospital of Qingdao University.70 cases of vulvar intraepithelial neoplasia and vaginal intraepithelial neoplasia were excluded,5cases of glandular epithelial abnormalities were excluded as well.In the end,2083 patients were included in the study,which inclouded 1121 cases of negative for intraepithelial lesion or malignancy(NILM),408 cases of atypical squamous cells undetermined significance(ASCUS),300 cases of low-grade squamous intraepithelial lesion(LSIL),126 cases of atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion(ASC-H)and 128 cases of high-grade squamous intraepithelial lesions(HSIL).The pathologocal results of colposcopy biopsy incloudrd994 cases of inflammation,551 cases of intraepithelial neoplasia(CIN)I,247 cases of CINII,231 cases of squamous cell carcinoma,4 cases of adenocarcinoma-in-situ and 8cases of adenocarcinoma.The cases diagnosed as NILM in LCT while as cervical CINI or more in biopsy were defined as “underdiagnosis”;the cases diagnosed ASCUS or LSIL in LCT while as cervical CINII or more in biopsy were defined as “underdiagnosis” as well;the cases diagnosed as ASC-H or HSIL while as cervical CINI or inflammation in biopsy were defined as “overdiagnosis”.The SPSS26.0 software was used to analyze the status of “underdiagnosis” and “overdiagnosis”,and to compare the discrepancies infemale between LCT and pathological results of colposcopy biopsy.The significance of HPV(human papillomavirus)type testing discrepancy of different cytological and pathological results was analyzed.Results: Of the 2083 patients aged 17 to 76 years with an average age of 40.76±10.753 were analyzed by age-groups.Kappa value of consistency check was 0.352 between LCT and pathological resuil of colposcopy biopsy and the discrepancy rate was34.37%(716/2083).The rate of underdiagnosis was 28.04%(584/2083)while overdiagnosis was 6.34%(132/2083).In LCT,the highest discrepancy rate was LSIL(53.67%),followed by NILM(35.86%),ASCUS(25.98%),and the lowest discrepancy rate was HSIL(11.72%),which was with statistically significant(P < 0.0025).The rate of missed diagnosis in LCT was 36.91%(402/1089).Among 2083 cases,1470 cases were tested for HPV type testing at the same time,and the highest rate of underdiagnosis(38.97%)and the lowest rate of overdiagnosis(2.78%)was in the group with HPV16/18 positive.The underdiagnosis rates in LCT of NILM,ASCUS and LSIL were 28.13%,49.00% and 42.00%,respectively,which were higher than those of HPV negative and other types of HPV positive,and those of high-grade cervical lesions were also higher than those of the other two groups.Among1470 high-risk HPV positive cases with different subtypes,the detection rate of CINII and abovewas highest in HPV16,accounting for 49.12%(196/399),followed by HPV33(47.76%),HPV31(34.09%),HPV45(33.33%)and HPV18(23.73%)statistically significant.To analyze the situation of HPV infection in cases with LCT results of NILM and ASCUS while pathological results of CINII and above,the proportion of CINII and above cases in different HPV types was HPV33(48.72%),HPV16(37.50%),HPV45(29.41%),HPV31(23.53%),HPV18(22.47%),HPV58(13.91%)and HPV52(10.23%)with statistically significant.The highest missed diagnosis rate of cases with pathological results of CINII and above was HPV33(48.15%),when the LCT results was NILM,which was statistically significant.The LCT results showed that the highest detection rate of CINII and above in high-grade lesions(ASC-H and HSIL)was HPV16/18 positive(92.68%),which was statistically significant.The pathological results of LCT and pathological result of colposcopy biopsy were grouped according to age.The detection rate of LCT for high-grade lesions and above increased with the increase of age.Among the pathological results of colposcopy biopsy,the CINII and above rate of patients over 60 years old was the highest,followed by the age group of 30-39 years old.With the increase of age,the differency rate between cytological and pathological results decreased gradually,and the difference rate was the highest among those under 30 years old,which was 38.27%.When LCT was diagnosed as NILM,the CINII and above ratio of 30-39 years old was the highest,which was19.05%,with statistical significance.When LCT was diagnosed as ASCUS,the incidence of CINII and above ratio was the highest(33.33%),which was statistically significant.When LCT was diagnosed as LSIL,CINII and above ratio was highest(27.50%),with no statistical significance(P > 0.05).Conclusion :1.The differency rate of patients with LSIL or under-LSIL high,which need further detection,rational referral of colposcopy to avoid missed diagnosis.2.When HPV16/18 was positive,the incidence of CINII and above was the highest in all levels of LCT results,and direct referral to colposcopy could minimize the missed diagnosis rate of high-grade lesions;when LCT was diagnosed as NILM or ASCUS,patients with HPV33,45,31,58 and 52 infection have a higher probability of CINII and above,and patients with NILM and HPV33 at the same time were most likely to be missed,which should be paid attention to by patients and doctors in clinic.3.Differency between LCT and pathological results of colposcopy biopsy decreases with the increase of age.There was a high possibility of missed diagnosis of high-grade lesions and cervical cancer in the age group of 30-39 years.Patients in this age group should be well educated,strictly screened and followed up to avoid missed diagnosis. |
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