The Application Of Conization Of Cervix Combined With Intraoperative Frozen Section Examination In Diagnosis And Treatment Of High Grade Squamous Intraepithelial Lesion

Objectives: To evaluate the value of application of conization of cervixcombined with intraoperative frozen section examination in diagnosis andtreatment of high grade squamous intraepithelial lesion which were diagnosedby colposcopy biopsy by contrast the pathological results of a variety ofdiagnosis and treatment of high grade squamous intraepithelial lesion.,and toassess the accuracy of the colposcopy biopsy.Methods: A retrospective study was carried out in169cases with CINⅡ~Ⅲ underwent conization of cervix combined with intraoperative frozensection examination between January2009and October2011in our hospital.All the patients were diagnosed by colposcopy biopsy in our hospital or otherhospitals and confirmed by the department of Pathology of our hospital. Acomparative analysis was carried out by the pathological results of colposcopybiopsy, intraoperative frozen section pathology and postoperative paraffinpathology of cervical conization specimens, pathology of uterine specimensafter hysterectomy by self-control method and by statistical analysis usingSPSS13.0software and statistical test by a χ~2test.Results:1.There are109of the169cases got same grade of intraoperativefrozen section pathology than colposcopy biopsy(the diagnosis coincidencerate of them is64.5%(109/169)), meanwhile16(9.5%)higher, and44(26.0%)lower. The difference rate of them is35.5%(60/169).The diagnosticaccuracy of intraoperative frozen section pathology is higher than colposcopybiopsy in statistically significant.2.There are153of the169cases got samegrade of postoperative paraffin pathology than intraoperative frozen sectionpathology(the diagnosis coincidence rate of them is90.5%(153/169) andincluding9cases of invasive cervical cancer,and the diagnosis rate of invasive cervical cancer is5.3%(12/169) of intraoperative frozen sectionexamination), meanwhile16(9.5%)higher (including3cases of invasivecervical cancer,and the missed diagnosis rate of invasive cervical cancer is1.8%(3/169) of intraoperative frozen section examination), and0(0%)lower.The diagnosis of the margins is exactly consistent between intraoperativefrozen section pathology and postoperative paraffin pathology, includingpositive margin of1cases of CIN Ⅱ,2cases of CIN Ⅲ,4cases of invasivecervical cancer.The positive margins rate is11.3%(7/60), negative marginsrate is88.7%(53/60)after conization of cervix.3. There are113of the169cases got same grade of postoperative paraffin pathology than colposcopybiopsy,(the diagnosis coincidence rate of them is66.9%(113/169)),meanwhile20(11.8%)higher(including12cases of invasive cervical cancer,and the missed diagnosis rate of invasive cervical cancer is7.1%(123/169) ofcolposcopy biopsy),and36(21.3%)lower.4.The accuracy of conization ofcervix for the diagnosing of high grade squamous intraepithelial lesion andinvasive cervical cancer could reach100%(86/86),and cure rate could be90.7%(68/75). The residual lesion rate is11.1%(3/27)in negative marginsand100%(1/1) in positive margins. The overall residual lesion rate is9.3%(7/75).Conclusion:1.Colposcopy biopsy is a preliminary diagnosis and screeningof high grade squamous intraepithelial lesion. It can further confirm thediagnosis of abnormal TCT examination results. There is the possibility ofmissed diagnosis of invasive cervical cancer.2.Intraoperative frozen sectionpathology has a high degree of consistency with postoperative paraffinpathology. It can accurately evaluate the margins and Situation within thecervical canal. It can find some of microinvasive and invasive cancer. Thereare some clinical value.3.Conization has the dual role of diagnosis andtreatment. The diagnosis of high grade squamous intraepithelial lesion Shouldwith conization pathology results shall prevail.The treatment of high gradesquamous intraepithelial lesion should be preferred conization of cervix.Thenext treatment will be according to the pathology, conization margins as well as the patient's fertility requirements, age, personal and other factors.4. Thereare some clinical value of the application of conization of cervix combinedwith intraoperative frozen section examination in diagnosis and treatment ofhigh grade squamous intraepithelial lesion.