To Analysis And Monitoring Of Residual Or Recurrence Risk Factors After Conization Of Cervical Intraepithelial Neoplasia

Objective:The aim of the present study is to analyze the clinical date of CIN patients,to study the relationship between the residual or recurrence of CIN patients after conization.Through the single factor and multivariate factors analysis,found high risk factors associated with postoperative recurrence of patients with CIN,and distinguish high-risk patients who relapse after CIN treatment,postoperative follow-up of closely to them.Also to assess the role of thinprep cytologic test(TCT)and human papillomavirus(HPV)test as predictors of recurrent disease after conization of cervical intraepithelial neoplasia.Materials and Methods:550women with cervical intraepithelial neoplasia(CIN)II-III on biopsy were included in this study.All women were treated with conization,the patients were followed up at 3,6,12 months after the conization.During these visits TCT and HPV test were used,if one of TCT and HPV test is positive,they need a biopsy of the colposcope.Recurrence definition:the pathological diagnosis of CIN within 6 moths after conization is the definition of residual;the pathological diagnosis of CIN over 6 moths after conization is the definition of recurrence.Using SPSS statistical software for statistical analysis,Pearson chi-square test and Logistic regression analysis and other methods.Through single factor and multivariate factors analysis,to study the relationship between the residual or recurrence of CIN patients after conization and patients,age production time,preoperative pathologic stage,gland involvement,preoperative ECC,the CIN3 lesion points,postoperative pathology margin,postoperative HPV persistent infection,postoperative HPV load and other factors.In this paper,the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)are used to indicate the performance of TCT and HPV test.Results:Among 550 follow-up patients,8.5% patients developed residual or recurrence during follow-up.The clinical date of CIN patients were analyzed by single factor analysis came that,the residual or recurrence of CIN was significantly correlate with production time,pathologic stage,gland involvement,the CIN3 lesion points,postoperative pathology margin,postoperative HPV persistent infection,postoperative HPV load(X2=4.002;3.922;9.511;7.162;4.848;5.825;15.735),the difference was statistically significant(P<0.05).But there was no correlation with patients,age,preoperative ECC(P>0.05).Multivariate logistic regression analysis was performed on the possible factors of recurrence of CIN.Production time,the CIN3 lesion point points,postoperative pathology margin,postoperative HPV load were independent risk factors for postoperative recurrence of CIN patients(OR=2.277;4.711;3.346;18.377),the difference was statistically significant(P<0.05).The TCT had a sensitivity of 75 % and specificity87 %in predicting a residual or recurrent disease;whereas HPV test had a sensitivity of 90 %and specificity 62 %,respectively;further more TCT combined HPV test had a sensitivity of 91 % and specificity of 90 % in the prediction of residual or recurrent disease.This shows that although cytology and HPV testing can be used alone for post-treatment risk assessment,but its combined detection can better play their respective advantages and reduce the rate of misdiagnosis after follow-up.Conclusions: The residual or recurrence of CIN was significantly correlated with production time,pathologic stage,gland involvement,the CIN3 lesion points,postoperative pathology margin,postoperative HPV persistent infection,postoperative HPV load and other factors.And there was no correlation with patients,age,preoperative ECC.Production time,the CIN3 lesion point points,postoperative pathology margin,postoperative HPV load were independent risk factors for postoperative recurrence of CIN patients.Furthermore TCT combined with HPV test is an effective way to predict residual or recurrent disease after conization.It is significant for diagnosis and treatment of cervical diseases.