Differential Analysis Of Biopsy Pathology In Cervical Cytology Negative/High-risk HPV Positive Patients

Objective:The objective of this paper is to analyze the histological and pathological results of2193 patients with cervical cytology negative/high-risk HPV-positive and explore the risk of CIN2 or more cervical lesions and related factors in cervical cytology negative patients,so as to provide references for rational shunt and reduction of missed diagnosis in cervical cytology negative/high-risk HPV-positive patients.Methods:A retrospective analysis was performed on 2193 women who underwent cervical biopsy with negative cervical cytology and positive high-risk HPV during August 1,2017and December 31,2018 at the Affiliated Hospital of Qingdao University.The basic data,liquid-based cell test,high-risk HPV and pathological results of the selected patients were analyzed.The incidence rates of different cervical lesions CIN1,CIN2,CIN3 and cervical cancer were analyzed.The correlation between different pathological types and high-risk HPV types,multiple HPV infections,age of patients,pregnancy and menopause status and other factors were further analyzed.References for reasonable shunt and reduction of missed diagnosis in cervical cytology negative/high-risk HPV-positive patients will be provided by exploring the risk of CIN2 and above cervical lesions and related factors in cervical cytology negative patients.Results:(1)Among the 2193 patients with negative cervical cytology/high risk HPV positive,Among them,287 cases with pathological findings were CIN2 or above,the incidence rate was 13.09%.162 cases(7.39%)were diagnosed with CIN2,117 cases(5.34%)were diagnosed with CIN3,and 8 cases(0.36%)were diagnosed with cervical cancer.There were 287 patients with lesions above CIN2,with an incidence rate of 13.09%.There was statistically significant difference in age among different cervical lesions in the four groups(P(27)0.05).Among them,the proportion of patients with CIN2-3 was the highest among those aged 30-39 years,and the proportion of cervical cancer was the highest among those aged≥50 years.(2)A total of 1622 cases underwent HR-HPV typing detection in these 2193 patients.Through the analysis of the rates of cervical lesions after different subtypes of HPV infection,it was found that HPV16(28.42%)had the highest incidence of lesions above CIN2.HPV31(25%),HPV33(22.85%),HPV58(11.86%),HPV51(10.6%),HPV52(9.94%)and HPV68(9.94%)were the next,and HPV18 ranked the 12th(8.29%),with statistical significance(χ~2=71.118,P(27)0.05).(3)Among the patients with single HPV infection,129 cases(13.65%,129/945)infected CIN2 or more lesions,while in the patients with mixed HPV infection,the incidence of CIN2 or more lesions was 14.74%(62/677),and there was no statistical significance between the two groups(χ~2=0.002,P(27)0.05).HPV co-infection did not increase the risk of cervical lesions above CIN2.(4)Comparing the incidence of various types of cervical lesions in HPV16 infected with non-HPV16 infected patients,the detection rate of CIN2 and above lesions in the HPV16 infected group was 28.43%,which was significantly higher than that in the non-HPV16 infected group(7.33%),and the differences were statistically significant(χ~2=128.724,P(27)0.001).In the HPV16 group,there was no significant differences in the detection rate of CIN2 or above in either HPV16 single infection or HPV16 mixed infection(P>0.05).(5)The analysis of high-risk HPV subtypes in patients with CIN2 or above lesions showed that the proportion of HPV16 infection cases was the highest,which was 42.07%,and the differences was statistically significant compared with other types(P(27)0.05).They were followed by HPV52(10.98%),HPV58(7.01%),HPV33(6.71%),HPV31(6.40%)and HPV18(4.88%).The total number of HPV16 and HPV18 infection cases in CIN2 or more lesions accounted for 46.95%.If HPV16 and HPV18 were used as the standard for colptoscopy biopsy shunt of TCT-negative patients,53.05%of these patients might be missed diagnosis of CIN2 or more lesions.Conclusions:Among cervical cytology-negative/high-risk HPV-positive patients,the incidence of lesions above CIN2 was 13.09%.In this group of patients,in addition to HPV16 and HPV18 subtype infection,HPV31,HPV33,HPV58,HPV51and HPV52 are also common infection subtypes.In clinical work,attention should be paid to the other high-risk HPV subtypes in addition to HPV16/HPV18 that cause lesions above CIN2,combined with the age of patient,HPV infection history and clinical manifestations,tranfer to a colposcopy reasonablely to reduce the risk of missing diagnosis of HSIL.