Analysis Of Risk Factors For Missed Invasive Carcinoma Under The Microscope In HSIL Diagnosed By Colposcopy-guided Biopsy

Objective To evaluate the risk factors of missed invasive carcinoma under the microscope(ICUM)in HSIL with analysis of the associate factors for missed ICUM in HSIL diagnosed by colposcopy-guided biopsy.Methods A retrospective study was performed on 1594 cases with diagnosis of HSIL in the colposcopy guided biopsy and treated by LEEP or extrafascial hysterectomy in the short term(8-34 days;average time,19 days)at the Department of Obstetrics and Gynecology,the First Affiliated Hospital of Nanjing Medical University,from December 2014 to December 2014.In order to analyze the risk factors of missed ICUM in HSIL,a case control study was conducted on 344 cases selected from them,who were grouped into 62 cases of cervical ICUM(including cervical squamous cell carcinoma stage Ia1,Ia2,and Ib1 whose lesions can’t be seen in naked eyes)and 282 cases HSIL(including CIN2、CIN2-3 and CIN3),according to the ultimate pathology.Result(1)Among the 1594 cases with HSIL diagnosed by colposcopy-directed biopsy,63 cases(3.95%)were missed diagnosis of ICUM,which consisted of 41 cases Ia1,4 cases Ia2 and 18 cases Ib1 in the ultimate pathology.The missed diagnosis rates of ICUM for CIN2、CIN2-3 and CIN3 were 0.98%,3.19% and 7.94%,respectively.(2)Analysis of associate factors for missed ICUM: Univariate analysis showed that patient age,visibility of the squamocolumnar junction(SCJ),the location of HSIL,atypical vessels,the number of different high-grade features,visible lesion size,the proportion of visible lesion size in ectocervical size and maximum linear length of visible lesion were all risk factors of missed diagnosis of ICUM(all P<0.05),except for cervical cytology before colposcopy(P>0.05).Multivariable analysis found that patient age,visibility of SCJ,atypical vessels and maximum linear length of visible lesion were associated with missed diagnosis of ICUM(OR: 1.828、10.105、7.904、2.836,P: 0.006、0.016、<0.001、0.013).For those younger than 50 years old,Multivariable analysis indicated that their age,visibility of SCJ,atypical vessels,visible lesion size and maximum linear length of visible lesion were associated(OR: 12.019、6.600、4.506、3.079,P: 0.002、<0.001、0.005、0.015).Conclusions With increasing age of patient,invisibility of SCJ,atypical vessels and maximum linear length of visible lesion ≥10mm,the risk of missed ICUM in HSIL diagnosed by colposcopy-guided biopsy will rise significantly.In addition,visible lesion size≥40mm2 is also the risk factor for those younger than 50 years old.Thereby,it is necessary to tighten follow-up and take immediate treatment for HSIL with these risk factors.