| Objective(s): This study mainly reviewed and analyzed the data of 481 patients who underwent cervical conization for the first time in the First Affiliated Hospital of Kunming Medical University,analyzed the relevant factors that affected the pathological escalation,positive surgical margins,and residual/recurrent lesions after cervical conization,and screened high-risk populations in order to provide reference for the formulation of personalized treatment plans for patients with cervical lesions.Methods: The clinical data of patients undergoing cervical conization(including Loop Electrosurgical Excision Procedure(LEEP)and Cold Knife Conization(CKC))in the First Affiliated Hospital of Kunming Medical University from October 2016 to June 2022 were collected.According to the inclusion and exclusion criteria,481 cases that met the requirements were finally selected as the study subjects.All patients underwent colposcopy biopsy or endoscopic curettage(ECC)before cervical conization,and were followed up in our hospital after surgery.If necessary,secondary surgery was performed.According to the postoperative pathological results,patients were divided into non pathological upgrade group(360 cases)and pathological upgrade group(121 cases);Patients were divided into two groups according to the status of the surgical margin after surgery: a negative surgical margin group(393cases)and a positive surgical margin group(88 cases);According to the follow-up results,the patients were divided into non focus residual/recurrence(434 cases)and focus residual/recurrence group(47 cases).The patient’s case data and postoperative follow-up data were collected for a retrospective study.The related factors of pathological progression,positive surgical margin,and focus residual/recurrence after cervical conization were analyzed,and their predictive value was evaluated.Results: 1.In 458 cases examined before surgery for Human Papillomavirus(HPV),the HPV infection rate was 94.98%,with type 16/18 infection being the most common type of infection.There was significant difference in 16/18 infection rate among different histological and pathological results after cervical conization(P<0.05).After pairwise comparison,there were statistically significant differences between CIN 2 and CIN 3 and between CIN 2 and cervical cancer in 16/18 infection rate(P<0.005,α’=0.005).Among the 431 cases of Thinprep Cytologic Test(TCT)performed before surgery,274 cases were TCT positive,and the TCT false negative rate was 36.43%.There were statistically significant differences in the TCT false negative rate among different histological and pathological results after cervical conization(P<0.05).After pairwise comparison,Carcinoma In Situ(CIS)and CIN 1,CIN 2 and CIS,CIN 2 and cervical cancer and CIN 3 and cervical cancer had significant differences in false negative results(P<0.005,α’=0.005).2.In 419 patients undergoing preoperative HPV and TCT combined screening,the detection rate of separate HPV tests was 94.51%,the detection rate of separate TCT tests was 62.53%,and the detection rate of HPV and TCT combined screening was97.61%.There was a statistically significant difference in the detection rate between different examination methods(P<0.05).After pairwise comparison,there were statistically significant differences in the detection rate between separate HPV tests and separate TCT tests,as well as between HPV and TCT combined screening and separate TCT tests(P<0.017,α’=0.017).3.Univariate analysis of pathological escalation after cervical conization showed that the number of deliveries,body mass index,preoperative TCT examination results,preoperative pathological results,and the number of preoperative pathological involvement quadrants were all related risk factors for pathological escalation after cervical conization(P<0.05).Further multivariate analysis showed that preoperative vaginitis,postoperative pathological results,and the number of quadrants involved by postoperative pathology were independent influencing factors for positive surgical margin after cervical conization(P<0.05).The area under curve(AUC)of the receiver operating characteristic curve(ROC)combined with three independent influencing factors=0.722,which has moderate predictive value for pathological progression after cervical conization.4.Univariate analysis of positive surgical margin after cervical conization showed that age at the time of surgery,number of deliveries,body mass index,preoperative TCT examination results,preoperative pathological results,number of preoperative pathological involvement quadrants,presence or absence of vaginitis before surgery,postoperative pathological results,number of postoperative pathological involvement quadrants,and whether postoperative pathological involvement of glands were all related risk factors for positive surgical margins after cervical conization(P<0.05).Further multivariate analysis showed that the presence or absence of vaginitis before surgery,preoperative pathological results,and postoperative pathological involvement in the number of quadrants were independent influencing factors for positive surgical margins after cervical conization(P<0.05).The combined AUC of three independent influencing factors is 0.810,which has a moderate predictive value for positive surgical margins after cervical conization.5.Univariate analysis of residual/recurrent lesions after cervical conization showed that age at the time of surgery,menopausal status,preoperative TCT examination results,preoperative pathological results,number of preoperative pathological involvement quadrants,postoperative pathological results,number of postoperative pathological involvement quadrants,whether postoperative pathology involves glands,whether postoperative HPV infection continues,and whether positive surgical margins were all related risk factors for residual/recurrent lesions after cervical conization(P<0.05).Further multivariate analysis showed that menopausal status,postoperative pathological results,postoperative HPV infection continues,and positive surgical margins were independent influencing factors for residual/recurrent lesions after cervical conization(P<0.05).The combined AUC of four independent influencing factors=0.887 has moderate predictive value for residual/recurrent lesions after cervical conization.Conclusion(s): 1.Currently,the type of HPV infection with the highest infection rate among patients with cervical lesions is still type 16/18.The combined screening of HPV and TCT has the highest detection rate,sensitivity,and positive predictive value for cervical lesions.2.The results of preoperative TCT examination,preoperative pathological results,and the number of preoperative pathological involvement quadrants are independent influencing factors for pathological escalation after cervical conization.The combination of the three influencing factors has moderate predictive value for the risk of pathological escalation after cervical conization.3.The presence or absence of preoperative vaginitis,postoperative pathological results,and postoperative pathological involvement in the number of quadrants are independent influencing factors for the positive surgical margin after cervical conization.The combination of the three influencing factors has moderate predictive value for the risk of positive surgical margin after cervical conization.4.Menopausal status,postoperative pathological results,postoperative HPV infection continues,and positive surgical margins are independent influencing factors for residual/recurrent lesions after cervical conization.The combination of the four influencing factors has moderate predictive value for the risk of residual/recurrent lesions after cervical conization. |
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