Clinical Analysis Of 1060 Cases Of Cervical Cancer And Precancerous Lesions With Cervical Cytology-negative/High Risk HPV-positive

Objective:To investigate the necessity of cervical cytology and high-risk human papillomavirus(HR-HPV)combined screening for cervical cancer and precancerous lesions,to explore the importance of the "three-step" screening program.Providing evidence for the optimal management in patients of cervical precancerous lesions and cervical cancer with cervical cytology-negative/HR-HPV positive in combined screening.Materials and methods:We collected 1060 cases of high-grade cervical epithelial lesions and cervical cancer with cervical cytology-negative/high risk HPV-positive thorough reviewing analysis who admitted to the affiliated women’s hospital,Zhejiang University School of Medicine(including both outpatient and inpatient department)from August 2013 to September 2018.1060 cases(9.35%)were selected from a total number of 11342 patients who were collected from the Pathologic Database firstly in the evidence of their preoperative colposcopy evaluation and cervical biopsy or postoperative pathological diagnosis of>HSIL/AIS.Results:(1)A total of 1060 patients were included,patient age range:20～71 years old,mean age:39.78 years old,median age:39 years old.A total of 727 cases(68.58%)in 30-49 year-old-group are with high risk.Among 1060 patients,734 cases(69.25%)with detailed birth history,including 36 cases(4.9%)have no birth,89 cases(12.13%)with gravida 1 time,189 cases(25.75%)with gravida 2 times,420 cases(57.22%)with gravida≥3 times.(2)Among 1060 cases,the pathological diagnosis of cervical precancerous lesions 1005 cases(94.81%),squamous cell carcinoma 50 cases(4.72%),adenocarcinomas 5 cases(0.47%).Among 55 cases of invasive cervical cancer,21 cases(38.18%)are≥50 years old.(3)Comparing the preoperative cervical biopsy pathological diagnosis with the postoperative paraffin sections pathological diagnosis,754 cases(71.13%)remains consistent,41 cases(3.87%)with upgraded postoperative pathological diagnosis.(4)Among 1060 cases,450 cases(42.45%)underwent loop electro surgical excision procedure(LEEP),581 cases(54.81%)underwent cold-knife conization(CKC),27 cases(2.55%)underwent hysterectomy,1 case underwent radical trachelectomy,and 1 case underwent cervical biopsy and endocervical curettage(ECC).(5)A total of 761 cases among 1060 cases received HR-HPV genotyping detection,380 cases were tested by HR-HPV PCR.Among 380 cases,HR-HPV 16 is primarily in single infection(67.39%),HR-HPV18 is primarily in mixed infection(78.26%),the non-HR-HPV16/18 is primarily in mixed infection(67.39%),and mixed infection accounted for 34.12%.Conclusion:For cervical cytology-negative and HR-HPV-positive women,even the colposcopy evaluation and cervical biopsy pathological diagnosis may misdiagnose high-grade cervical lesions.Among the female with cervical cytology-negative and HR-HPV-positive,especially in female≥50 years old,there may be misdiagnosis of cervical precancerous lesions or invasive cervical cancer.