| Part Ⅰ HPV infection in a hospital in Qujing,Yunnan ProvinceObjective:To study 12,511 cases of opportunistic cervical cancer screening in the gynecology outpatient clinic of Qujing Maternal and Child Health Hospital,Yunnan Province.Analyzeing the HPV infection and its typing and distribution characteristics,and to explore the triage effect of TCT testing methods on HPV-positive patients and the diagnostic effect on cervical lesions.It can provide theoretical basis for the development of cervical cancer prevention and control strategies and screening programs in the region,and vaccination in the region.Methods: Data were collected from 12,511 subjects who visited Qujing Maternal and Child Health Hospital in Yunnan Province from January 01,2019 to December 31,2021 and were randomly tested for HPV typing at the gynecology outpatient clinic.The HPV infection rate,HPV typing and distribution characteristics were retrospectively analyzed,and the HPV positivity rate and typing were compared at each age.The patients who tested positive for HPV were triaged by TCT testing,colposcopy was performed according to the referral colposcopy guidelines,and cervical tissue biopsy was performed for those with abnormal colposcopy,and biopsy pathology results were used as the gold standard to derive the specificity and sensitivity of TCT for detecting high-grade cervical lesions and above.Result:1.Among 12511 female patients screened for opportunistic cervical cancer in the gynecology outpatient clinic of Qujing City,Yunnan Province,2253 were HPV-positive and 10258 were HPV-negative,with an overall HPV infection rate of18.01%.15.05% of the HPV infections were high-risk HPV-positive and 2.96% were low-risk HPV-positive.Monotypes were positive 10.96%,and mixed types were positive 4.21%.2.The common high-risk HPV infection subtypes in order were: HPV52(23.04%),HPV16(11.94%),HPV58(10.08%),HPV53(8.92%),HPV51(6.57%),HPV18(6.53%),and the common low-risk HPV infection subtypes in order were:HPV81(7.23%),HPV42(3.24%),HPV6(2.62%),and HPV11(1.42%),respectively.3.HPV positivity rates varied by age,with 11.81% positive at <25 years;34.40% positive at 25-34 years;26.32% positive at 35-44 years;11.50% positive at45-54 years;and 15.98% positive at ≥55 years;the differences in HPV positivity rates were not statistically significant across age groups(P < 0.05).HPV infection had two high prevalence age stages,25-34 years and 35-44 years,respectively.4.Among 2253 HPV-positive patients,1137 colposcopic cervical biopsies were performed,suggesting 606 cases(53.30%)of ≥HSIL and 531 cases(46.70%)of ≤LSIL.Among those with ≥HSIL,528 cases had TCT ≥ASC-US and 78 cases had TCT for NILM;among those with ≤LSIL,319 cases had TCT ≥ASC-US and 212 cases had TCT for NILM;therefore,the specificity(true negative/(true negative +false negative))of TCT test for the diagnosis of ≥ HSIL was obtained as 0.7310(212/(212 +78)),and the sensitivity(true positive/(true positive + false negative))was0.8713(528/528+78).5.There were 562 cases of HSIL on biopsy histopathology,and the three most common HPV subtypes among the monotypes were: HPV16(31.49%),HPV58(12.99%)and 52(11.74%);37 cases of squamous carcinoma,and the three most common HPV subtypes among the monotypes were: HPV16(37.84%),HPV18(In 7cases of adenocarcinoma,there were only 2 HPV types in the monotypes: HPV16(42.86%)and 18(14.29%).Conclusion:1.the HPV positivity rate in a hospital in Qujing,Yunnan Province was 18.01%,the total positive rate for high-risk HPV types was 15.05%,and the single type of HPV infection was higher than the multiple types of HPV infection;2.Among HPV infections,high-risk HPV infections are most common with type52,followed by type 16,58,53,51,and 18;common low-risk HPV infections are:HPV type 81,42,6,and 11,respectively.The distribution of types should be taken into account when selecting preventive vaccines.3.Trends in HPV infection were age-related,with two high prevalence age groups of 25-34 years and 35-44 years,respectively.4.The specificity of TCT test for the diagnosis of ≥HSIL was 73.10% and the sensitivity was 87.13% in 2253 patients with positive HPV test.In our local trial of HPV primary screening,TCT triage may be a superior detection method that can be extended to other hospitals and regions.5.Among patients diagnosed with ≥ HSIL at a hospital in Qujing,the most common HPV infections were HPV16,HPV58,HPV52 and HPV18 in that order,so cervical cancer screening should be more concerned about whether HPV58 and 52 types need to be referred for colposcopy.Part2 Analysis of factors associated with HPV persistent infection after HSIL coningObjective: To retrospectively study HPV infection in patients undergoing cervical conization for HSIL and HPV regression at 6 and 12 months after conization;to analyze the factors associated with persistent HPV infection after conization.After understanding clearly the risk factors for persistent HPV infection after conization in patients with HSIL,risk assessment,optimal treatment selection and the most reasonable management follow-up mechanism will be carried out for the ultimate benefit of patients.Methods: A total of 531 patients who underwent cervical conization for high-grade squamous intraepithelial lesions(HSIL)at Qujing Maternal and Child Health Hospital in Yunnan Province between January 01,2019 and December 31,2021 were collected,and the general information of the patients(including: age,menopause status,education level,number of pregnancies and births,etc.),surgical procedure,postoperative HPV results at 6 and 12 months postoperatively were recorded using electronic case review and telephone follow-up.The clinical data were recorded by electronic case review and telephone follow-up,including general information of patients(including age,menopause,education level,pregnancy and delivery),surgical procedure,postoperative pathology,number of quadrants involved and surgical margins,HPV results at 6 months and 12 months after surgery,and statistical analysis of factors affecting postoperative HPV positivity.The study was reviewed and approved by the hospital ethics committee.Result:1.Among 1.531 HSIL patients,the HPV positivity rate was 97.36%(517/531),and the HPV negativity rate was 2.64%(14/531).The monotypic HPV positivity rate was 74.27%(384/517)and the multiple HPV positivity rate was 25.73%(133/517),with the monotypic HPV positivity rate being higher than the multiple HPV positivity rate.Among HPV infections,the most common HPV type 16 was 48.40%(257/531),followed by HPV type 58 22.03%(117/531),type 52 17.33%(92/531),HPV type 1836.97%(37/531),and HPV type 33 6.21%(33/531),respectively.The rate of multiple positivity containing HPV type l6 was 52.63%(70/133),and the rate of multiple positivity of other subtypes was 47.37%(22/133).2.The conversion rates of HPV at 6 and 12 months after surgery were 58.99%(305/517)and 69.25%(358/517),respectively,and the overall persistent HPV positivity rate was 13.73%(71/517 cases).One of the patients had a different subtype of HPV infection preoperatively than postoperatively.3.HPV positivity in patients at 6 months postoperatively was associated with age,delivery,pregnancy,multiple infections,HPV type,positive cut edge,and number of quadrants involved in the lesion,with statistically significant differences(P< 0.05).There was no statistically significant difference independent of the surgical procedure(P > 0.05).Multi-factor logistic regression analysis revealed that the factors affecting HPV conversion at 6 months after surgery were delivery,multiple infections,number of lesions involved in the quadrant and positive margins,and the difference was statistically significant(P < 0.05).4.HPV positivity in patients at 12 months postoperatively was associated with age,number of pregnancies and deliveries,positive cut margins,and number of quadrants involved in the lesion,and the difference was statistically significant(P <0.05).The differences were not statistically significant(P > 0.05)independent of factors such as HPV type and surgical method.Multi-factor logistic regression analysis revealed that the factors affecting HPV conversion at 12 months after surgery were age,positive cut edge and the number of quadrants involved in the lesion,and the difference was statistically significant(P < 0.05).The difference was statistically significant(P < 0.05),and the probability of positivity increased 0.039 times for each1-year increase in age(OR = 1.039);1.926 times for patients with multiple infections compared with patients with single infections;2.129 times for patients with positive surgical margins compared with negative patients;and 0.251 times for each 1 increase in the number of lesion involvement quadrants.Conclusion:1.The HPV positivity rate among 531 patients with HSIL was 97.36%,and the rate of single type HPV positivity was higher than that of multiple HPV positivity.The most common type was HPV16,followed by HPV58,52,HPV18,and HPV33,respectively.The rate of multiple positivity for HPV containing HPV type l6 was 52.63%,and the rate of multiple positivity for other subtypes was 47.37%.2.The conversion rate of HPV at 6 and 12 months after cervical conization was 58.99% and 69.25%,respectively.One of the patients had different HPV infection subtypes preoperatively and postoperatively.3.Age,multiple infections,positive cut margins,and number of quadrants involved in the lesion are risk factors for persistent postoperative HPV positivity. |
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