| Objective:According to the preliminary screening results of cervical cancer with positive HR-HPV and negative cytology,the results of colposcopy,cervical disease examination and clinical data of such patients were collected to explore the accuracy of colposcopy and its diagnostic value in patients with cervical lesions with negative cytology and positive HR-HPV.Methods:Using the method of retrospective analysis,the clinical data of patients with cervical cancer screened of positive HR-HPV and negative cytology who were selected in the department of gynaecology of the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2019.Including patients’ age,family situation,contraception,cervical cytology results,HR-HPV test results,the colposcope examination results and cervical biopsy pathology diagnosis results.The HPV infection,colposcopy suspected diagnosis,cervical biopsy,the relationship between colposcopy and HPV infection and the coincidence degree between colposcopy and cervical examination were analyzed.SPSS22.0 software was used for data processing and statistical analysis.Results:1.General information:General data:a total of 229 patients with cervical cancer were screened in the Gynecology Clinic of the second affiliated Hospital of Kunming Medical University from January 2016 to December 2019.229 patients with positive HR-HPV and negative cytology underwent colposcopy and cervical biopsy at the same time.The pathological tissue results of cervical biopsy were taken as the gold standard.Among the 229 patients,tthere were 121 cases of chronic cervicitis(52.84%),37 cases of CINI(16.16%),57 cases of CINII/III grade(24.89%)and 14 cases of invasive carcinoma(6.11%).1.1 age:A total of 229 patients were included in this study,with an age distribution ranging from 19 to 71 years old,an average age of 41.03±11.78 years old,and a median age of 41 years old.Group-based statistics were performed at the age of 10 years old.The results showed that the majority of patients with cervical cancer screening of positive HR-HPV and negative cytology in our hospital were 20-59 years old.The proportion was 93.01%.1.2 Fertility status:Among them,only 223 patients had a detailed reproductive history.According to the pathological results,the birth conditions of patients with chronic cervicitis and>CIN lesions were classified and counted.The independent sample t test was used to compare and analyze the number of pregnancies and births of the two groups of patients.The results showed that there was no significant difference in the time of pregnancy and delivery between the two groups(P>0.05).1.3 Contraceptive methods:Only 221 patients recorded detailed methods of contraception,and the results of pathological examination were also classified as those of patients with chronic cervicitis and>CIN lesions.The results showed that there was no significant difference in the number and proportion of patients using different contraceptive methods between the two groups(P>0.05).2.HR-HPV infection:229 patients were tested for HPV,of which 131 cases were tested for typing and 98 cases for quantitative testing.In the 131 patients with HPV typing,the infection rate of HR-HPV 16/18 was slightly lower than that of non-16/18(45.04%vs.54.96%),and the number of HR-HPV 16 infection was the largest in the single HPV category,followed by 18,52,58,56,39,33,53,59,31,81.In addition,98 patients were quantitatively detected by HPV.According to viral load level,the number of HPV virus low load group(1～99.99RLU/CO),medium load group(100～999.99RLU/CO)and high load group(>1000RLU/CO)were 63,19 and 16 respectively3.Possible conditions of colposcopy3.1 131 cases of patients with HPV testing,35,14 and 72 cases of single infection of HPV 16,18 and non-16/18 were detected by HPV typing,respectively,the results of three kinds of colposcope examination(positive cervical lesions,cervical columnar epithelium ectopic and unsatisfactory colposcopy)were compared in HPV16,18 and the ratio of non 16/18 group,The results showed that when colposcopy was possible,the detection rate of HPV18 was the highest.There was significant difference in the detection rate between non-16/18 type and non-16/18 type(P<0.05),but there was no significant difference between HPV16 type and non-16/18 type(P>0.05).When colposcopy was suspected to be cervical columnar epithelial ectopia,the detection rate of non-16/18 type was higher,but there was no significant difference compared with HR-HPV16 and 18 type(P>0.05).When colposcopy was presumed to be unsatisfactory,there was no significant difference in the detection rate among the three groups(P>0.05).It can be seen that when the type of HR-HPV infection is 16 or 18,the result of colposcopy is more inclined to the possibility of cervical lesions,but when colposcopy is suspected to be ectopic cervical columnar epithelium or dissatisfied with colposcopy,the difference between different HPV types is not significant.3.2 Comparison of three colposcope examination results in various viral load distribution,the results showed that when the colposcope examination results of cervical lesions were possible,the rate in the high viral load group was significantly higher than that in the low viral load group,the difference was statistically significant(P<0.05),but there was no significant difference between the high viral load group and the medium viral load group(P>0.05);When colposcopy diagnosed cervical columnar epithelial ectopia,the proportion of low viral load group was the highest,and there were significant differences between the groups with medium and high viral load(P<0.05).When colposcopy was presumed to be unsatisfactory,there was no statistical significance in the ratio of colposcopy among the three(P<0.05).This study indicated that when viral load was less than 100RLU/CO,colposcopy examination was more likely to be diagnosed as cervical columnar ectopic,and when viral load gradually increased to more than 1000RLU/CO,colposcopy was more likely to be diagnosed as cervical lesions.4.Pathological results of cervical biopsy under colposcopy4.1 Statistical analysis was conducted on the results of single infected patients with HPV type 16,type 18 and non-16/18,it was found that the patients with chronic cervicitis accounted for 50.41%(61/121),and the patients with pathological diagnosis of CIN or above accounted for 49.59%(60/121).The probability of ≥CIN lesions caused by single HPV 16 type,18 type and non-HPV 16/18 type were 60%,57.14%and 43.06%respectively.The proportions of chronic cervicitis,≥CIN lesions and invasive carcinoma in HR-HPV16,18 and non-16/18 types were compared,respectively.The results showed that there was no significant difference between different HPV infection types regardless of the disease detection results of chronic cervicitis or>CIN lesions.However,in invasive carcinoma,the positive rate of HPV16 type was significantly higher than that of non-16/18 type(P<0.05),but the positive rate of HPV18 type was almost the same.The data in this study suggested that HPV 16/18 type had a significant carcinogenic tendency,but compared with other types,there is no significant statistical significance in the incidence of ≥CIN lesions.4.2 The relationship between each viral load group and the pathological results of cervical tissues at all levels was compared and analyzed respectively,and there was no significant difference in the probability of cervical CIN Ⅰ lesions in each viral load group(P>0.05).There were differences in the probability of CIN Ⅱ/normal lesions in the cervix among three groups(P<0.05).After comparison between the two groups,it showed that the probability of CIN N/L lesions in the medium and high load groups was significantly higher than that in the low load group(P<0.05),but there was no difference between the medium and high load groups(P>0.05).The data of this group showed that compared with the low viral load group,the medium and high viral load groups were more likely to develop CIN Ⅱ/normal lesions,while there was no significant difference in CINⅡ/Ⅲ lesions among different viral load groups.5.Colposcopy results and cervical biopsy results5.1 With cervical biopsy pathologic results as the reference standard,the overall coincidence rate of colposcopy was 48.91%,the colposcope examination of cervical columnar epithelium of the coincidence rate is 71.43%,and the possible coincidence rate of colposcopy was 63.41%,dissatisfied with colposcopy can not evaluate the accuracy of cervical lesions.Comparison of the coincidence rates of the former two cases showed that P<0.05,indicating that the difference in the coincidence rates of the two cases was statistically significant.Further analysis showed that the diagnosis of cervical columnar epithelium was more sensitive,specific and accurate than that of colposcopy.5.2 Using the pathological results of cervical biopsy as the reference standard,the coincidence rates of colposcopy Findings of Type Ⅰ,Ⅱ and Ⅲ transformation zones were 65.28%,62.16%and 22.89%,respectively.The coincidence rate of each type of transformation zone was compared and the difference was significant(P<0.05).By pairwise comparison of the coincidence rate of the transformation zones of each type,it was found that there was no statistical significance in the coincidence rate between the transformation zones of type Ⅰ and Ⅱ,but it was significantly higher than that of the transformation zones of type Ⅲ.Further analysis showed that when the proposed result was ectopic cervical columnar epithelium or possible cervical lesions,the sensitivity was the highest when the transformation zone was type I,and the specificity was the highest when the transformation zone was type Ⅲ.As transformation zone by type Ⅰ gradually shift for type Ⅱ,colposcope examination accuracy decreases gradually,but compared with type Ⅱ transformation zone Ⅲtransformation zone to the accuracy of the diagnosis of cervical lesions might rise slightly,which may be related to the unsatisfactory exposure of type Ⅲ conversion area under colposcopy,suspected cervical or cervical canal lesions,cervical biopsy and cervical curettage.6.Analysis of the influencing factors of the accuracy of colposcopy:the proposed results of colposcopy in our hospital were ectopia of cervical columnar epithelium,unsatisfactory colposcopy and possible cervical lesions,and the cervical biopsy results could be divided into chronic cervicitis and ≥CIN lesions.If the result of colposcopy is columnar epithelium of cervix,and chronic cervicitis is suggested by disease examination,they will be determined to be consistent.If the proposed result of colposcopy is the possibility of cervical lesions,but the cervical lesions suggest>CIN lesions,the two are also determined to be consistent,otherwise,they are not.In this study,univariate analysis was conducted on patients’ age,fertility history,contraceptive method,HPV infection type,cervical transformed zone type and HPV viral load level,etc.The results showed that the type of cervical transformed zone and HPV viral load level were the related factors affecting the accuracy of coldoscopy diagnosis in our research center(P<0.05).Conclusions:1.In this study,colposcopy fitting was consistent with pathological diagnosis under colposcopy biopsy,and when the HPV typing test indicated 16/18 positive and/or quantitative determination of HPV was greater than 100RLU/CO,and the transformation zone was type Ⅰ and Ⅱ,the coincidence rate of colposcopy diagnosis in this study was higher.2.As far as this research center is concerned,the patients with non-HPV16/18 persistent infection or viral load greater than 100RLU/CO should also be referred to coldoscopy as soon as possible,and the clinical management of such patients should not be neglected,so as to avoid the possibility of missed cervical cancer lesions.3.The false negative rate of cervical cytology in our center is high,Therefore,it is not recommended to use only a single cervical cytology test as the main means of cervical cancer screening in our center,and combine with HPV test or other test methods as far as possible,and refer to coldoscopy if necessary.4.This study shows that the type of cervical transformation zone and the level of HPV virus load are the relevant factors that affect the accuracy of colposcopy diagnosis in this research center,when the colposcopy result is suspicious,the screening should be combined with the clinical symptoms,HPV infection type,duration,colposcopy satisfaction and other factors to reduce the missed diagnosis of cervical lesions. |
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