| Objective:(1)By analyzing the pathological outcomes of patients with cervical high-grade squamous intraepithelial lesion(HSIL)after cervical conization,the importance of pathological grading and diagnosis of cervical biopsy is clarified.At the same time,discuss the factors that affect the pathological outcomes of patients with each biopsy pathological grade after cervical conization,and then provide a reference for the choice of treatment methods for patients according to the pathological grade.(2)By analyzing the pathological outcomes of CIN 2 patients of childbearing age after conization,the high-risk factors that affect the pathological upgrade of CIN 2 patients of childbearing age after conization were discussed.Predict the risk of pathological escalation after cervical conization in patients with CIN 2 of childbearing age,and further explore the feasibility of conservative treatment.Methods : Based on the research purpose,the research work is divided into two parts:(1)The clinical pathological data of HSIL patients diagnosed and treated in our hospital were retrospectively collected,and the cases that met the research conditions were screened according to the inclusion and exclusion criteria.The self-contrasted method was used to analyze the pathological outcomes of HSIL patients with various pathological grades after cervical conization,and single factor analysis was used.The method further analyzed the factors affecting the pathological outcomes of patients with different pathological grades after conization.(2)From the first part of the included subjects,the patients of childbearing age who were diagnosed as CIN 2 by cervical biopsy were screened out.Single factor analysis and binary logistic regression analysis were used to explore the independent risk factors that affect the pathological upgrade of patients with CIN 2 of childbearing age after conization.To further draw the ROC curve to predict the risk of pathological escalation after cervical conization in patients with CIN 2.Results:(1)A total of 952 HSIL patients were enrolled in this study.A total of 322 patients were diagnosed as CIN 2 by cervical biopsy.There were 110 patients with pathological degradation after conization,and the degradation rate was 34.16%(110/322).There were 118 patients with pathological conformity after conization,and the conformity rate was 36.65%(11/322).There were 94 patients with pathological upgradation after conization,of which 1 patient was upgraded to cancer,the upgrade rate was 29.19%(94/322),and the probability of upgrade to cancer was 0.31(1/322);A total of385 patients were diagnosed as CIN 3 by cervical biopsy.There were 54 patients with pathological degradation after conization,and the degradation rate was14.03%(54/385).There were 292 patients with pathological conformity after conization,and the conformity rate was 75.84%(292/385).There were 39 patients with pathological upgraded to cancer after conization,the upgrade rate was 10.13%(39/385).HSIL patients with different pathological grades of cervical biopsy had significant differences in pathological outcomes after conization(P<0.05).Cervical biopsy is pathologically diagnosed as CIN 2patients,and the pathological degradation rate after conization is the highest(34.16%),and it is significantly higher than that of CIN 2-3 and CIN 3 patients(34.16%VS13.06%&14.03%),the difference is statistically significant(P<0.05);Cervical biopsy is pathologically diagnosed as CIN 3 patients,and the probability of pathological upgrade to cancer after conization is the highest(10.13%),and it is significantly higher than that of CIN 2 and CIN 2-3 patients(10.13%VS0.31%&0.82%),the difference was statistically significant(P< 0.05).The diagnosis of cervical biopsy pathological CIN 2-3 is an informal diagnosis,and its biological behavior is more inclined to CIN 3.The results of self-contrasted method and univariate analysis showed that the factors affecting the pathological outcomes of HSIL patients after cervical conization are different due to the different pathological grades of cervical biopsy,and the highest pathological diagnosis of cervical biopsy is the pathological outcomes of patients with CIN 2 after cervical conization.Factors affecting the pathological outcomes of patients with cervical conization after cervical conization with the highest pathological diagnosis of cervical biopsy as CIN 2 were the results of TCT and parity(P<0.05);The factors affecting the pathological outcomes after cervical conization in patients with the highest pathological diagnosis of cervical biopsy as CIN 3 were age,contact bleeding,TCT test results,HPV test results,biopsy pathological glands,and menopausal status(P<0.05).(2)There are significant differences in the pathological outcomes of CIN 2 patients in different age groups of childbearing age(P < 0.05).The probability of pathological upgrade after conization in the 21-30 year group is lower than that in the 31-40 year group and 41-50 year group(16.07%VS28.81%&36.93%),the difference was statistically significant(P<0.05),and the older the age,the higher the probability of pathological upgrade after conization.Through univariate analysis and binary logistic regression analysis,it was found that age and TCT examination were independent risk factors for pathological escalation after conization in CIN 2 patients of childbearing age(P<0.05).Draw the ROC curve of age predicting the pathological upgrade of CIN 2 patients after conization.According to the Youden index,the cut-off value of age is 37.5 years old.Conclusions:(1)The pathological outcomes of HSIL patients after cervical conization is different due to the different pathological grades of cervical biopsy.Although the pathology classification classifies both CIN 2(P16+)and CIN 3 patients as HSIL,there are significant differences in the biological behavior of CIN 2 patients and CIN 3 patients.Therefore,it is necessary to pay attention to the pathological grading of cervical biopsy of HSIL patients in clinical practice.When choosing a treatment plan,a comprehensive selection can be made based on factors such as the patients’ age,TCT examination results,parity,fertility requirements,menopause,patient compliance,follow-up conditions,and own wishes.(2)The pathological upgrade rate after cervical conization in patients with CIN 2 of childbearing age increases with age,but the total upgrade rate is less than 40%,and the probability of directly upgrading to cancer is low.For CIN 2 patients who are younger than 37.5 years old,have future family planning,have good compliance,and voluntarily assume risks,the treatment time can be appropriately relaxed for short-term conservative treatment. |
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