The Accuracy And Risk Factors Of Diagnosing HSIL Via Colposcopic Biopsy In Postmenopausal Woman

Objectives:The study aimed to evaluate the accuracy and related influencing factors of diagnosing high grade squmous intraepithelial lesion(HSIL)via colposcopic biopsy.Explore the clinical diagnosis and treatment of HSIL in postmenopausal Women.Methods:We retrospectively reviwed the clinical features of 182 postmenopausal women who diagnosed with HSIL by colposcopy biopsy between January 2008 and February 2017 at Tian jin medical university hospital.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 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.Resuits:Conization group:1.32 cases of HSILwere included in this group,the accordance of HSIL diagnosis between colposcopic biopsy and definitive surgery was 68.8% with an underestimation rate of 6.3% and overestimation rate of 6.3%,and the positive rate of postoperative tangential margin was 25.0%?2.Univariate analysis showed that HPV positive,type ? transformation,multiple biopsies,lesion involved the quadrant and lesion involved the gland were risk factors for the positive margin(P<0.05);3.Logistic regression analysis showed that ? transformation,multiple biopsies,lesion involved the quadrant and lesion involved the gland were independent risk factors for the positive margin(P<0.05);Total hesterectomy group:1.150 cases of HSIL were included in this group,the accordance of HSIL diagnosis between colposcopic biopsy and definitive surgery was 80.0% with an underestimation rate of 9.3% and overestimation rate of 10.7%?2.Univariate analysis showed that rnenopuase time <5 years,cytology<LSIL,ECC<LSIL,and lesion without gland involved were significantly correlated with overestimation of HSIL(P<0.05).Irregular vaginal bleeding,cytology>LSIL,HPV16/18 positive,? transformation,ECC were HISL,and lesion with gland were significantly correlated with underestimation of HSIL(p<0.05).3.Logistic regression analysis showed that:cytology<LSIL,ECC<LSIL and lesion without gland involved were independent risk factors of overestimation;Irregular vaginal bleeding,cytology>LSIL,HPV16/18 positive,? transformation,ECC were HSIL,were independent risk factors for underestimatioConclusions:1.The high grade cervical lesions in postmenopausal women have their special characteristics.The accuracy of the diagnosis of the colposcopy biopsy is influenced by the clinical features of the patients and the related factors of the colposcopy.When the biopsy of the colposcopy was diagnosed of HSIL,rnenopuase time <5 years and cytology and ECC pathology were all less than LSIL may related with overestimation HSIL.2.When the biopsy pathology was HSIL,with irregular vaginal bleeding,the diagnosis of colposcopy and the ECC pathology are more than HSIL,lesion with gland,we should be vigilant for the deficiency of the colposcopy diagnosis and the risk of infiltrating cancer.