Improved Three-step Technique In Clinical Application Research Of Diagnosis And Treatment Of Cervical Lesions

Objectives:To investigate the clinical value of improved "three-step" technique (improved "three-step" technique) in the diagnosis and treatment of cervical lesions.Methods:The study in Qilu Hospital treatment of1098patients were collected in August2010-May2012subjects aged20-66years old. The average age of these patients was35.48years old. They have not history of uterine surgery, non-pregnancy. All subjects caught accept the TCT and HR-HPV DNA check, the discovery of TCT abnormal ASCUS and above lesions and/or HPV-positive taken colposcopy and cervical biopsy and/or ECC performance according to the colposcopy, or LEEP surgery. Satisfactory colposcopy, microscope lesions, the direct line of the biopsy of the lesion; TCT results for ASC-H, AGC, HSIL and colposcopy are not satisfied, the line multiple biopsies (cervical select3,6,9,12points) and the ECC. HSIL patients without cervical conization contraindications, direct line LEEP diagnostic conization surgery. Analysis of cytology and HR-HPV DNA results, colposcopy biopsy results, conization surgical and pathological findings, to take self-control laws, Analysed line with the rate and specificity of the test results, to evaluate the improvement of the three-tiered technology in the diagnosis and treatment of cervical lesions in the clinical roleResults:1.1098cases subjects TCT examination, inflammation or normal in882cases (80.32%), abnormal cases.216cases (19.68%), ASCUS51cases (4.70%), ASC-H53cases (4.81%). LSIL77cases (6.97%), HSIL35cases (3.20%).2. HC2 examination, the overall infection rate in the population of35.97%,395cases of high-risk HPV-positive, the average age of (35.87±10.68) years,703cases of HPV-negative, the average age (39.95±11.76) years of age.The age of the HPV-positive group was significantly less than the HPV-negative group.The difference was statistically significant, P<0.01.3. TCT results of each category of HR-HPV DNA infection:Inflammation or normal HR-HPV DNA positive rate was28.91%.The positive rate of ASCUS group was50.98%.The positive rate of ASC-H group was58.49%.The positive rate was76.62%in LSIL group. The positive rate of HSIL group was94.29%. We found in pace with the elevated levels of TCT diagnostic results, HPV positive rate was significantly increased. The statistical test difference is statistically significant.(P<0.01).4. The TCT198cases of unusual or high-risk HPV DNA positive patients had done colposcopically directed biopsy. Pathological findings of inflammation, there are84cases (42.42%)%,CINI29cases (14.65%), CIN Ⅱ39cases (19.70%), CIN Ⅲ32cases(16.16%), invasive carcinoma2cases (1.01%), warts6cases(3.03%).5Different pathological Group HPV infection: Inflammation of34.52%of the people are positive, CINI58.62%, CIN Ⅱ84.61%. CIN Ⅲ96.87%,100%of invasive cervical cancer, genital warts50.00%.6.Colposcopy association between the guide and multiple biopsies results with TCT and HR-HPV DNA positive predictive value:48cases TCT results for ASCUS patients received colposcopy-guided biopsy. HR-HPV DNA positive group found Level lesions accounted for37.50%, negative group, only8.33%of the high-level lesions. TCT results for ASC-H group of53patients received colposcopy and biopsy, which HR-HPV DNA positive group found that58.06%of high-level lesions, negative group, only9.09%of the high-level lesions. TCT LSIL74patients underwent colposcopy-guided biopsy,35.09%high-level lesions, including HR-HPV DNA positive group found negative group, only5.88%of the high-level lesions. TCT results for HSIL23cases colposcopy-guided biopsy, HR-HPV DNA positive by21cases,17cases of high-level lesions, two cases of SCC, high-level lesions found was90.47%,2cases of HR-HPV DNA biopsy pathological findings are high-level lesions (lesion detection rate was100%). The712cases TCT HSIL, HR-HPV positive patients directly cervical LEEP circumcision, pathology results are high-level cervical intraepithelial neoplasia.8Colposcopic biopsy results with cervical cone resection of pathological findings contrast LEEP surgery in70patients, preoperative and postoperative pathological findings in full compliance with the rate of81.69%(58/71), the postoperative pathological findings.1-2levels by9.86%(7/71), down1-2levels by8.45%(6/71); application of chi-square test, significant differences in the results of both pathological diagnosis with x2=9.81, p<0.005.Conclusion:1. Liquid-based cervical cytology (TCT) combined with HP-HPV DNA detection could significantly increase the detection rate and accuracy of cervical lesions. It is conducive to the early detection of cervical lesions2. Colposcopically directed biopsy can further improve the detection rate of cervical intraepithelial neoplasia (CIN), further processing to guide clinical significance.3.For HSIL, HR-HPV DNA-positive patients, no cervical cone cut contraindications, direct line conization surgery.4.Improved three-step technique in the diagnosis of cervical lesions, can not only improve the accuracy of diagnosis but also avoid the over-diagnosis and over-treatment.