Analysis Of HPV Infection And Residual Lesions After Loop Electrosurgical Excision Procedure In Patients With Cervical Intraepithelial Neoplasia

Objectives: To investigate the human papillomavirus (HPV) infection of thecervical intraepithelial neoplasia (CIN) and residual lesions after loop electrosurgicalexcision procedure (LEEP).Methods: The pathology confirmed CIN424cases in the biopsy directed byvaginoscope from January,2003to December,2011at the First Affiliated Hospital ofFujian Medical University were collected. And the HPV genotypes, pathology gradeafter the cervix, the LEEP or/and the hysterectomy were comparatively analysed.Results:1. The positivity rate of HPV in patient with CIN was87.44%, and thepositivity rate of HPV in CINⅠ,CINⅡ, CINⅢ were66.67%,91.43%and88.96%respectively, and there was a statistically significant difference (P=0.038). Thepositivity rate of multiple HPV in CINⅠ,CINⅡ, CINⅢ were25.00%,37.50%and24.14%respectively, there was no statistically significant difference (χ~2=2.285，P=0.319). HPV16,58,31,52and18are the first five commonest genotypes in CIN inthis research. The prevalence of different HPV types from highest to lowest orderwere HPV16,58,53in CINⅠ;HPV16,58,31in CINⅡ and CINⅢ.2. Compared to the histology result, the false negative rate of TCT is7.99%(23/288). The histology result from77cases ASCUS showed that8cases(10.39%)with cervical intraepithelial neoplasiaⅠ(CINⅠ),25cases (32.47%) with CINⅡ,41cases (53.25%) with CINⅢ and3cases (3.89%) with ISCC. In comparisonwith TCT and cervical histology result, the rate of coincidence was25.00%(13/52) for LSIL,91.96%(103/112) for HSIL. But HSIL with histology hashigher consistency than that of LSIL with histology (χ~2=76.922，P=0.005). 3. The coincidence rate of pathology between biopsy and LEEP was57.10%(181/317); the downgrade rate of pathology was28.39%(90/317); the upgrade rate ofpathology was14.51%(46/317), and the10cases were confirmed ISCC (3.15%). Theage above50years old is high risk factor of missed diagnosis.4. In comparison of the pathology between LEEP and hysterectomy: thefrequency of downgrade pathology were74.16%(132/178), and the negative ratewere37.08%(66/178); the frequency of upgrade pathology, unchanged pathologywere2.81%(5/178) and23.03%(41/178). The pathologic diagnose after LEEP aboveCINⅠ, glandular involvement, positive preoperative ECC are risk factors of residualCIN undergoing LEEP.Conclusion: The cervical intraepithelial neoplasia was subject to the HPVinfection. LEEP is a kind of safe and effective method for the diagnosis and treatmentof CIN，but it has a high residual lesions rate when used to be a treatment forCINⅡand CINⅢ, hysterectomy is a selection for those patients who are old and haveno needs of fertilite.