Analysis Of Missed Diagnosis Factors In High-grade Squamous Intraepithelial Lesion Of The Cervix

Objective:Through a retrospective analysis of the clinical data and information of 39 cases of missed diagnosis diagnosed as HSIL by diagnostic conus resection in the department of gynaecology and obstetrics of the second hospital of jilin university from January 2017 to December 2018,who were highly suspected to have high-grade cervical lesions and whose vaginoscopy biopsy was normal or benign disease.At the same time,48 cases of patients in the non-missed diagnosis group who were admitted to our hospital at the same time due to the high suspicion of high-grade cervical lesions by colposcopy biopsy as normal or benign disease,and subsequently confirmed by cone resection pathology in our hospital as no intraepithelial lesions were set as the control group.Compared two groups of patients with diagnosis and treatment of cervical intraepithelial lesion screening process,this paper analyzes patients at risk of misdiagnosis and the existing positive intervention,aimed at improving screening process middle and high level cervical intraepithelial lesion detection rate,and clarify the diagnostic cone cutting to reduce the high level in diagnosis of cervical squamous intraepithelial lesions value,to provide individualized screening management of cervical cancer lesion before clinical thinking.Methods:Preliminary statistics of 39 patients in the missed diagnosis group and 48 patients in the non-missed diagnosis group were conducted through EXCEL table.SPSS 25.0 software was used to analyze the data.The measurement data were required to conform to normal distribution,which was expressed as `x± s.Counting data is represented by the number of examples(n)or the constituent ratio(%).Univariate analysis was performed by using ?2 test for age,menopause,clinical manifestations,TCT results,hr-hpv results,type of cervical transformation area,number of cervical biopsy,columnar epithelial area,cervical metastasis,complete cervical resection,colposcopy and colposcopy biopsy in the negative cases.Multiple-factor logistic regression was used for multivariate analysis of independent risk factors for missed high-grade cases in colposcopy biopsy-negative cases.The statistically significant P value <0.05 was considered statistically significant.Results :1.The average age of patients in the non-missing group was 44.8125±7.292,and the average age of the patients in the missed group was 48.2821±10.773.There was no significant difference in the mean age distribution between the two groups(P>0.05).The average pregnancy time of non-missing patients was 2.08±1.028(1~4 times),the average birth time was 1.27 ± 0.736(0~4 times),and the average pregnancy time of the missed group was 2.36±1.328(0-6 times),with an average yield of 1.54.±0.884(0 to 4 times),there was no statistically significant difference between the two groups in the pregnancy and delivery(P>0.05).There was a statistically significant difference in vaginal contact bleeding between the two groups(P<0.05),but no significant differences in other clinical manifestations and signs(P>0.05).2.Single factor analysis results show that age>55 years,menopause,vaginal contact bleeding,HR-HPV positive,TCT results >LSIL,type ?TZ,colposcopy diagnosis results >LSIL were significant associated with misdiagnosis of HSIL(P<0.05).There was no significant correlation between the number of cervical biopsy,the lesion area,the complete visualization of the cervix with the missed diagnosis of HSIL(P>0.05).3.Multi-factor logistic regression analysis showed that type? TZ(OR: 11.661,95% CI: 1.633-83.266),HR-HPV positive(OR: 8.41,95% CI: 1.438-49.193),TCT> LSIL(OR: 7.273,95% CI: 1.509-35.051),colposcopy results > LSIL(OR: 4.982,95% CI: 1.338-18.546)is an independent high-risk related factor for missed diagnosis of HSIL in the pre-cancerous screening process.4.Among the 39 cases of HSIL in the missed diagnosis group,27 cases of cervical biopsy tissues were stained with immunohistochemistry,among which 2 cases were only stained with P16 and 25 cases were stained with P16+Ki67,among which P16 positive rate was 100% and Ki67 positive rate was 96%.5.Sixteen patients underwent ECC,including 7 cases in the non-missed diagnosis group and 9 cases in the missed diagnosis group.Among 9 patients with HSIL who missed diagnosis,4 patients were diagnosed with ECC less than or equal to LSIL,5 patients with >LSIL,and the sensitivity of ECC diagnosis for HSIL was 55%.Conclusion:1.P16,Ki67 can improve the accuracy of cervical biopsy in the diagnosis of HSIL.2.The accuracy of ECC diagnosis is not high,but it often provides important additional information in specific patients,which improves the detection rate of HSIL and makes up for a part of HSIL cases missed by cervical biopsy.3.Type? TZ,HR-HPV positive,TCT > LSIL,colposcope results > LSIL are independent risk factors for the misdiagnosis of HSIL.4.For those who do not have the above risk factors,comprehensive consideration should be given to age,fertility,surgical willingness and follow-up conditions.For those who have the above risk factors for missed diagnosis,multi-point biopsy under colposcope and ECC have certain limitations,and cone resection can be be used to diagnose and treat cervical diseases.