The Accuracy Of Diagnosing High Grade Cervical Intraepithelial Neopiasia Via Colpscopic Biopsy

Objectives:The study aimed to determine the accuracy and related influencing factors of diagnosing high grade squmous intraepithelial lesion (HSIL) via colposcopic biopsy.Methods:We retrospectively reviewed the medical records of women who were diagnosed with HISL by colposcopic biopsy and had surgery within 6 months between January 2009 and January 2015 at Women’s Hospital School of Medicine Zhejiang University. Accordant diagnosis of HISL via colpscopic biopsy was affirmed if it was consistent with the diagnosis by definitive surgery specimen, while overestimation was affirmed if LSIL or less (e.g. condyloma, inflammation and others) was diagnosed by definitive surgery and underestimation was affirmed if invasive cancer was diagnosed by definitive surgery. Comparing clinical pathological parameters, chi-square test and logistics regression were conducted to analyze relevant factors of effectiveness of colposcopic biopsy.Results:The accordance of HSIL diagnosis between colposcopic biopsy and definitive surgery was 80.0% with an underestimation rate of 6.6% and overestimation rate of 13.4%.Univariate analysis showed that menopuase, cytology<LSIL, HPV positive, colposcopy≤LSIL, ECC≤LSIL and lesion without gland involved were significantly correlated with overestimation of HSIL (all P<0.05).Irregular vaginal bleeding, cytology>LSIL, colposcopy≥HISL, ECC≥HISL, multiple biopsies, and lesion without LSIL were significantly correlated with underestimation of HSIL (all p<0.05).Logistic regression analysis revealed that:cervical cytologyator≤LSIL,diagnosis of colposcopy≤LSIL,ECC≤LSIL and lesion without gland involved were independent high risk factors of overestimation;Irregular vaginal bleeding, diagnosis of colposcopy≥HSIL,ECC were HSIL,multiple biopsies,were independent risk factors for underestimation,while lesion with LSIL was the low independent low risk factor for underestimationConclusions:1. The accuracy of diagnosing HSIL via colposcopic biopsies was influenced by many factors, and there are certain proportions of overestimation and underestimation.2. Risk of overestimation should be noticed in condition colposcopic biopsies suggested HISL, while cervical cytology, diagnosis of colposcopy and ECC were ≤LSIL, without gland involved.3. Risk of underestimation should be noticed when colposcopic biopsies suggested ≥HISL and diagnosis of colposcopy and ECC were HSIL, with irregular vaginal bleeding and multiple biopsies,in which circumstance, pathological results after sugery may show infiltrating carcinoma.The risk of cancer may be lower in patients with LSIL.