Significance Of Multi-point Biopsy And TCT In Cervical Conization

Objectives:Through retrospective analysis,to study the application value of colposcopic cervical multi-point biopsy combined with cervical conization in the diagnosis and treatment of cervical high-grade squamous intraepithelial lesions and early cervical cancer,To compare the difference of the residual cervical lesions residual rate between the two groups of patients who had the residual cervical multi-point biopsy after conization and those who had the residual cervical multi-point biopsy and TCT at the same time after conization.Methods:From June 2013 to October 2019,198 cases of cervical multi-point biopsy under colposcope and pathological diagnosis of CIN Ⅱ-Ⅲ,cervical microinvasive carcinoma or suspected cervical invasive carcinoma were collected from the gynecological clinic of the Second Affiliated Hospital of Kunming Medical University.The age,the number of pregnancies and births,the infection of HPV,the results of preoperative cytology and the characteristics of clinical manifestations were analyzed.The differences between the results of colposcopic cervical multi-point biopsy and the pathological diagnosis after CKC,the pathological diagnosis after CKC and the pathological diagnosis after hysterectomy were analyzed.The differences in the detection of residual cervical lesions between the CKC group(group A)and the Improved CKC group(group B),as well as the Improved CKC group(Group B1),the Improved CKC group(Group B2)were analyzed retrospectively.Results:1.In 198 patients,172 were examined for HPV before operation,with a positive rate of94.77%(163/172).HPV16 was the subtype with the highest infection rate of mixed infection and single infection.The infection rate of HPV presented an"n" distribution with the increase of age,with the highest infection rate of HPV in the age range of 30-49 years.In 198 patients,132 were examined for TCT before operation,including 100 with abnormal cytology and 32 with nilm.2.103 cases(52.02%)(103/198)were consistent with the pathological diagnosis of cervical CKC,95 cases(47.98%)were inconsistent.33 cases(34.74%)were upgraded in pathological diagnosis,62 cases(65.26%)were degraded in pathological diagnosis.The missed diagnosis rate of 13 cases of cervical microinvasive carcinoma by colposcopy was 6.57%(13/198).3.The final pathological diagnosis of CKC combined with colposcopy was cervical cancer in 18 cases,with a high incidence of 35-55 years old;CIN lesions in 156 cases,with a high incidence of 25-45 years old;the data of the two groups were compared and found that the high incidence of cervical cancer group was 10 years later than that of CIN group on average;the patients in the two groups were poor in age,pregnancy and childbirth times,mode of production,sexual hemorrhage,HPV infection and cervical cytology There was no significant difference(P>0.05),indicating that these factors were the common high risk factors of cervical cancer and CIN lesions.4.There was significant difference in the detection rate of residual cervical lesions between group B1 and group B2(χ2=6.48,P<0.05).The residual rate of lesions in group A was higher than that in group B,but because the number of cases in group A was small,more objective data needed to be obtained.Conclusions:1.HPV infection is mainly single type,HPV 16 type is the most common,HPV infection rate is "n" type distribution with the increase of age,the highest age of HPV positive rate is 30-49 years old.HPV 16,58,18,52 and 33 were the top five subtypes of HPV,and HPV 16 was the highest subtype of mixed infection and single infection.2.The incidence age of cervical invasive cancer tends to be younger,and its high incidence age is 10 years later than that of CIN group on average.It is a long and continuous process for CIN to develop into cervical cancer,which takes 8-12 years or even longer.3.Colposcopic cervical multi-point biopsy combined with cervical conization is the best way to diagnose CIN Ⅱ-Ⅲ and early cervical cancer at present.The combination of the two can complement each other and reduce the rate of missed diagnosis.4.Cervical CKC is expected to find the hidden lesions in the residual cervical canal through the combination of multi-point biopsy of residual cervical margin and TCT examination of residual cervical canal.In terms of assessing whether there is residual lesions in the residual cervical canal,it can avoid omission as much as possible.According to the pathological results of residual cervical margin and TCT,a reasonable,targeted and personalized follow-up plan is developed to carry out the follow-up More rigorous cytology or colposcopy monitoring,so as to achieve as accurate treatment as possible.5.It is still necessary to carry out further clinical research with large sample size and multi center to find a better auxiliary method to avoid residual lesions and over diagnosis and treatment at the same time in CKC,and to ensure the clinical treatment effect as much as possible while taking into account the quality of life of patients after operation.