Analysis Of Cervical Multi-point Biopsy And Cervical Conization For Diagnosis And Treatment Of Cervical Intraepithelial Neoplasia And Early Cervical Cancer

Backgrounds and ObjectiveCervical cancer is the fourth most common cause of cancer-related death among women worldwide.About 265700 women died of cervical cancer in 2012 alone.The vast majority of these women are from undeveloped regions,accounting for 85% of the global incidence and the second leading cause of cancer death among women in developing countries.Lesions in the cervical intraepithelial neoplasia(cervical intraepithelial neoplasia,CIN)is with the cervical invasive cancer(invasive cervical carcinoma,ICC)closely related to the development of a set of pathological changes,in recent years,the low grade squamous intraepithelial lesions(low grade squamous intraepithelial lesion,LSIL)and high-grade squamous intraepithelial lesion(high-grade squamous intraepithelial lesion,HSIL),and the cervical cytology Bethesda reporting system(the Bethesda system for reporting cervical cytology,TBS)has a good correspondence,LSIL contains CIN?and papillary immature metaplasia(papillary immature metaplasia,PIM),and HSIL includes CIN?and CIN?,although this term in pathology and clinic application of more and more,but for the sake of convenience,clinical doctors still multi-purpose CIN.Most of the LSIL patients' lesions can be resolved naturally,and the risk of cervical cancer will be greatly increased in women with high-level CIN,namely HSIL.Cervical cancer can usually be prevented by screening and treating precancerous lesions,so the diagnosis and treatment of CIN is a key step in the prevention of cervical tumors.In recent years through the application and spread of cervical cancer screening,such as cytology,human papilloma virus(human papillomavirus,HPV)check,colposcopy,cervical biopsy,such as screening,the CIN and cervical cancer can be early diagnosis,early treatment,at present the overall mortality of cervical cancer in our country has been in a significant decline,but the incidence of CIN showed a trend of younger age,the incidence of cervical cancer is still high.Colposcope cervical multi-point biopsy plays a central role in cervical cancer screening.It is simple to operate,has a small wound and is effective,but as a diagnostic tool,its accuracy and repeatability are limited.Cervical cone resection is not only the gold standard for the diagnosis of CIN and cervical cancer,but also an effective treatment method.Intraoperative frozen section can provide pathological results in a very short period of time,which can play a guiding role in the local resection of cervical lesions.In this study,we retrospectively evaluated the value of colposcope cervical multi-point biopsy and cervical cone resection in the diagnosis and treatment of cervical intraepithelial neoplasia and early cervical cancer,as well as the necessity of frozen pathological examination during cervical cone resection.Materials and MethodsThe clinical data of 143 patients with cervical intraepithelial neoplasia and suspected microinvasion admitted to the first affiliated hospital of Zhengzhou university from August 2017 to October 2018 were collected and sorted out.All the patients in the study had completed the multi-point cervical biopsy under colposcope before surgery,including those who were sent to the department of pathology of our hospital for diagnosis after receiving a cervical biopsy in the colposcope room of our hospital's outpatient department,and those who were diagnosed as CIN or suspected invasive cancer after receiving a consultation of the department of pathology of our hospital with the pathological sections obtained by colposcope biopsy in other hospitals.All patients meet the sexual life history,not in the gestation period,there is no history of hysterectomy,patients aged from 19 to 64 years old,average age(38.47±8.5).On admission,the main complaints were abnormal findings in cervical discharge screening,vaginal contact bleeding,abnormal leucorrhea and irregular menstruation.A retrospective study was conducted on these 143 cases,102 of which were sent for rapid frozen pathological examination from intraoperative cervical conus excision for patients hospitalized from August 2017 to July 2018,and the remaining 41 cases were sent for routine examination directly for patients hospitalized from August 2018 to October 2018.Through contrast method,analysis of cervical multi-point biopsy under colposcope pathological results cervical cold knife cut cone intraoperative frozen pathological results of postoperative routine cervical cold knife cutting cone wax block the pathologic results and conventional wax block pathological results after total hysterectomy,it is concluded that the cervical cone cut method of comparison and colposcope multi-point biopsy pathology results difference,and compare the intraoperative frozen pathological examination with the accuracy of conventional pathology after surgery.Results1.Among the 143 patients,108 of them had completed TCT examination before the multi-point biopsy of colposcope,and 83 of them had abnormal results,with a positive rate of 76.85%(83/108)and a missed rate of 23.15%(25/108).There were 128 cases of perfect HPV detection,including 4 cases of HPV negative,124 cases of positive,sensitivity 96.88%(4/124),false negative rate of 3.12%(4/124),a single HPV infection rate of 65.32%(81/124),multiple HPV infection rate of 34.68%(43/124).The top five HPV types were HPV16(62.10%),HPV58(16.13%),HPV18(9.68%),HPV52(7.26%)and HPV33(5.65%).2.93 cases of routine pathology after cervical coning resection were completely consistent with the pathological results of multi-point biopsy under colposcopy,with an overall coincidence rate of 65.03%,and 50 cases(34.97%)of non-conformity.Among them,11 cases(7.69%)of pathological examination after cervical coning resection were upgraded compared with the results of biopsy under colposcopy,and 39 cases(27.27%)were downgraded.3.The cervical cone cut method intraoperative frozen pathology with routine postoperative pathological results of total coincidence rate was 42.16%(43/102),postoperative the intraoperative pathologic upgrade was 55.88%(57/102),intraoperative frozen pathological results with postoperative pathologic results of ?= 0.05 level between the two,statistically significant difference(P=0.001),the intraoperative frozen pathological results with conventional postoperative pathology exists obvious difference.4.There were a total of 18 patients with residual lesions at the margin or the tip of the cone after cervical conus resection,and the positive rate of the margin and the tip of the cone was 7.62%(11/143)and 4.90%(7/143),respectively,according to the postoperative routine pathology.Among the 11 patients with positive surgical margins,the intraoperative rapid freezing pathology was consistent with the postoperative routine pathology in 7 cases,no abnormalities were found in 4 cases,and the surgical margins were upgraded to positive lesions in postoperative examination.Among the 7 patients with positive cone tip,4 cases had the same intraoperative rapid freezing pathology as the postoperative routine pathology,3 cases had no intraoperative abnormality and the postoperative cone tip was upgraded to positive lesions.No patients with positive intraoperative pathological cutting edge or tip of cone were found,and they were demoted to chronic inflammation.Conclusion1.There are obvious limitations in the diagnosis of cervical intraepithelial neoplasia and early cervical cancer by colposcope multi-point biopsy.2.Cervical coning resection is not only the gold standard for diagnosis,but also an effective treatment method.3.Frozen pathological examination during cervical cone resection can be used as intraoperative reference,but postoperative routine pathology is still needed for final diagnosis.