Analysis Of The Necessity Of Histological Examination In Patients With Persistent High-risk HPV Positive And TCT Negative In Cervix

Objective:To study the histological results of the patients with persistent high risk HPV positive and TCT negative,and analyze the necessity of histological examination.Methods: To collected the cervical HPV typing test indicated that high-risk HPV was positive and TCT expression was negative conducted in the Minda Hospital of Hubei Minzu University for Nationalities from October 01,2017 to November 30,2021,that is,the expression was inflammatory reactive cells and/or non-epithelial reactive cells（NILM）.And histological examination of cervix under colposcopy was performed in Minda Hospital of Hubei University for Nationalities,there are clinical data of 269 patients in all.To statistics and analysis the cervical histological examination results of different HPV subtypes,different age groups and menopausal status of patients,and compared separately the cervical histological examination results of HSIL and above.Results: 1.The age and histological results:the 269 patients included in the study were 21-64 years old,with an average age of（45.00±9.97）years.Among them,157 cases（58.36%）were normal or cervical inflammation,64 cases（23.79%）were LSIL,43 cases（15.99%）were HSIL,and 5cases（1.86%）were cervical cancer.All of them were squamous cell carcinoma,and the detection rate of HSIL or above was 17.85% about.2.Distribution characteristics of HPV subtypes:（1）The 269 patients included in this study were analyzed for high-risk HPV subtypes.The top six genotypes were HPV16（including simple infection and multiple infection）in 107 cases（39.78%）,HPV52 in 40 cases（14.87%）,HPV18 in 25 cases（9.29%）,HPV58 in 18 cases（6.69%）,and HPV31 in14 cases（5.20%）,12 cases（4.46%）were HPV33 type.Multiple infections are double-counted.There was significant difference in the detection rate of HSIL or above lesions among high-risk HPV infection patients of different subtypes（P=0.029）.（2）There were 124 negative TCT and HPV16/18 positive patients,among which 44 cases（35.48%）had HSIL or above,there were 145 negative TCT and other high-risk HPV positive patients,among which 4 cases（2.76%）had HSIL or above,and there was statistically significant difference in the detection rate of HSIL and above between the two groups（P<0.001）.（3）Univariate analysis of this study showed that HPV16 infection was a risk factor for HSIL or above lesions.（4）According to whether HSIL and cervical cancer were detected in TCT negative high-risk HPV16 positive patients,ROC curve was made.The area under the curve（AUC）for predicting the occurrence of HSIL and cervical cancer with persistent HPV16 infection was 0.790,the sensitivity was 87.5%,and the specificity was70.6%.3.Among the 269 patients in this study,156（57.99%）were simply infected with HPV,and 113（42.01%）were multiple infected with HPV.The Cervical histological examination results were divided into three groups: normal or cervicitis,LSIL,HSIL and cervical cancer.The proportions of HPV infection were 52.87%,57.81% and 75.00%,respectively.The proportions of multiple HPV infection in the three groups were 47.13%,42.19% and 25.00%,respectively.The differences in the proportions of single HPV infection and multiple HPV infection in the three groups were statistically significant（P=0.025）.There was no significant difference in the detection rate of HSIL or above in single infection and multiple infection of HPV16,18,52 and 58（P=0.912,P=0.490,P=0.905,P=0.829）.4.Patients were divided into different age groups as follows: 7（2.60%）≤ 24 years old,31（11.52%）25-34 years old,84（31.23%）35-44 years old,100（37.18%）45-54 years old,and 47（17.47%）55-65 years old.There was no significant difference in the detection rate of HSIL or above among different age groups（P=0.979）.5.269 patients were divided into pre-menopausal group（n=163,60.59%）and menopausal group（n=106,39.41%）according to menopause.The detection rate of HSIL and cervical cancer in the pre-menopausal group was 14.11%,and that in the menopausal group was 23.58%.The difference was statistically significant（P=0.047）.Conclusion: 1.In TCT negative cases,the histological examination under colposcopy should be performed directly for persistent HPV16/18 infection,but for other persistent HPV subtype infection,especially HPV52,58,33 and 31 positive patients also have high detection rate of HSIL and cervical cancer,so cervical histological examination is necessary.2.When TCT is negative,multiple HPV infections do not increase the severity of cervical lesions.3.When TCT is negative but high-risk HPV infection persists,there is no significant difference between age groups,but postmenopausal women have a higher detection rate of HSIL and cervical cancer,which should be paid attention to.