Clinical Analysis Of 856 Cases Of High-grade Cervical Intraepithelial Neoplasia Diagnosed And Treated By Cold Knife Conization

Research background:At present,cervical cancer is still one of the major malignant tumors that lead to women's death.The incidence of cancer in women's malignant tumors is second only to breast cancer and colorectal cancer.The incidence of cervical cancer in developing countries accounts for 85%of the global incidence.Cervical intraepithelial neoplasia(CIN)is a precancerous lesion of invasive cervical carcinoma(ICC).The occurrence and development of cervical cancer is closely related to it,including CINI,CINII and CINIII.CINI is called a low-grade cervical intraepithelial neoplasia,and CINII and CINIII are collectively referred to as high level cervical intraepithelial neoplasia.The vast majority of low-grade CIN can decline naturally,while high-grade CIN has a greater risk for cervical cancer.Therefore,the early detection,diagnosis and active treatment of high grade CIN have been widely recognized.In recent years,with the popularization of cervical cancer screening and the scientific application of the three step technology(cervical cytology to colposcopy to histopathology),the detection rate of high grade CIN increased year by year,and the onset age of patients showed younger trend.Colposcopy-directed punch biopsies(CDB)under colposcopy is a simple and effective way to diagnose CIN.The results provide important evidence for further treatment of cervical lesions.However,because CIN is usually multicentric lesion,there are different levels of lesions in different parts.The diagnosis based on CDB results can be delayed because of low diagnosis and partial cervical cancer is missed.On the other hand,excessive diagnosis can result in excessive treatment of the uterus resulting from the direct resection of the uterus.Therefore,it has an important role in cervical conization in the diagnosis and treatment of high grade CIN and is also of great clinical significance for patients with microinvasive carcinoma(MIC)who desire to maintain their fertility.After conization,the positive margin of the incisal margin is an important factor for the residual and recurrence of the lesion,which leads to more factors that have positive margin after conization.Therefore,if we can find the factors leading to the positive margin,we will provide evidence for clinical treatment,and establish the best surgical treatment plan,reduce the positive rate of the margin,and achieve the maximum curative effect.Objective:To explore the significance and value of cervical conization in the treatment of high grade CIN and the factors that cause the positive margin of cutting edge.Methods:from January 2012 to December 2016,a total of 856 patients diagnosed with high grade CIN(CINII/III)in Dalian obstetrics and Gynecology Hospital who underwent colposcopy cervix biopsy and underwent cervical cold knife conization were retrospectively analyzed.The pathological results of cervical biopsy under colposcopy and cold knife conization of cervix under preoperative colposcopy were compared and analyzed by self control method.The patients'age,menopausal status,parity,HPV test results,TCT examination results,pathological grading,postoperative pathology,cervical epithelial glands involvement and postoperative margin status were recorded and analyzed.From age,menopausal status,parity,HPV test results,lesion grade and postoperative pathology,6 factors related to cervical epithelial glands were analyzed.Using SPSS 18 statistical software for data processing and statistical analysis,count data using?~2 test,multivariate analysis using Logistic regression,P<0.05 was statistically significant.Results:1.Of the 856 patients,767 patients underwent TCT examination,685 cases showed abnormal results,the positive rate was 89.31%,the results showed no abnormalities in 82 cases,and the missed diagnosis rate was 10.69%.2,63 cases of HPV infection were negative,793 cases were positive,the sensitivity was 92.64%,the false negative rate was 7.36%,the single infection rate was 72.38%,the multiple infection rate was 27.62%;the HPV positive rate of CINII was 82.35%at the end of diagnosis,the HPV positive rate of CINIII was 93.11%,and the positive rate of cervical cancer HPV was 98.88%.The 5 subtypes of common HR-HPV infection were HPV16(58.76%),HPV58(17.28%),HPV33(13.49%),HPV52(11.60%),and HPV31(10.09%).3,856 patients preoperative and postoperative pathological results coincidence rate was60.28%,the rate of non conformity was 39.72%,postoperative pathological upgrades accounted for 19.04%,postoperative pathological downgrading accounted for 20.68%,missed diagnosis of cervical invasive cancer 89 cases,accounting for 10.4%of the total proportion.4,856 cases of patients with positive margin of resection were positive in201 cases,the positive rate was 23.5%.(age>50 years;?~2=12.313,P<0.05),menopause(?~2=6.062,P<0.05)and HPV infection(?~2=13.319,P<0.05),CIN lesions(?~2=70.008,P<0.05)and cervical epithelial gland involvement(?~2=46.163,P<0.05)and postoperative patients with positive margin,producing an unrelated(?~2=2.523,P>0.05).Multifactor analysis showed that age,HPV infection,and lesion level were risk factors for positive margin of postoperative resection.HPV infection,single infection group OR was 1.066(95%CI:0.481 to 2.362),and multiple infection group OR was 1.799(95%CI:0.788~4.104);lesion level factors in cervical cancer CINIII,OR values were15.564(95%CI:2.127 to 113.898)and 69.929(95%CI:9.144 to 534.771).5,comparing285 patients with pathological results after conization and two operative pathology,206patients with high grade CIN were cured.The cure rate was 78.16%.There was no significant difference between the high grade CIN group and the MIC group in terms of cure rate,?~2=6.083 and P>0.05.55 cases(43.31%,55/127)cut two operation patients with positive margin after the pathological examination showed that 27 cases of residual disease,(17.09%,27/158)cut two operation margin of negative patients after pathology showed residual disease,compared to two,the difference was statistically significant(?~2=23.616,P<0.05),indicating a positive margin and residual lesions related.6,856patients,163 cases of postoperative complications,the incidence is 19.04%,including early and late bleeding(159 cases,18.57%),cervical adhesions(1 cases,0.12%),postoperative infection(3 cases,0.35%).7.Postoperative follow-up in 571 cases(74cases with positive margins,497 cases with negative margins)and no further treatment were followed up for 1 years-3 years.187 patients were lost during follow-up.Of them,276 patients were rechecked regularly,and 108 cases were rechecked for 1 years.In the follow-up period,42 patients had a recurrence rate of 10.93%.The recurrence rate of the positive margin patients was 23.19%(16/69),and the recurrence rate of the negative margins was 8.25%(26/315).The difference between the two groups was statistically significant(?~2=12.96,P<0.05).Conclusion:1.In the diagnosis and treatment of high grade CIN,conization of the cervix is still of great significance and value.It is also safe and feasible for MIC patients with fertility requirements.2.Age(>50 years),menopause,HPV infection,and CIN lesions are the risk factors for the positive margin of postoperative resection.The best surgical treatment plan should be made before the operation,and the maximum effect should be obtained.3.The positive margin of the cutting edge is a risk factor for the residual/recurrence of the lesions after conization,but the patients with negative margin also have the risk of recurrence,and they should be reviewed regularly after conization.