Accuracy And Influencing Factors Of Colposcopy In Diagnosis Of Cervical Squamous Intraepithelial Lesions

Objective:To analyze the accuracy and related factors of colposcopy in the diagnosis of cervical squamous intraepithelial lesions.Methods:A total of 467 patients with low-grade cervical squamous intraepithelial lesion(LSIL)and high-grade cervical squamous intraepithelial lesion(HSIL)diagnosed by colposcopy,who had complete results of Thinprep Cytologic Test(TCT),human papilloma virus(HPV)test,and clear indications for colposcopy were included in the study.Patients who were suggested to meet the surgical indications based on pathological findings underwent either loop electrosurgical excision procedure(LEEP),cold knife conization(CKC)or total hysterectomy.Using those with the highest histopathological grade as the final diagnosis,we retrospectively analyzed the accuracy of pseudo diagnosis by colposcopic images,pathological diagnosis by cervical multi-point biopsy under colposcopy,and diagnosis by univariate and multivariate analysis of the influence of menopausal status,transformation zone,and high-risk HPV infection status on the accuracy of pseudo diagnosis of squamous intraepithelial lesions of the cervix on colposcopic images by self-control.Results:1、Among the 467 patients,the age distribution was 26-64 years(mean 52.3±5±7.35 years,grouped according to menopausal status:185 premenopausal,282postmenopausal;Patients were grouped according to the type of transformation zone:238were in type Ⅰ transformation zone,149 were in type Ⅱ transformation zone,and 80 were in type Ⅲ transformation zone;Patients were divided according to high-risk HPV status:301 in the high-risk HPV16 and 18 positive group,116 in the high-risk HPV other subtype positive group,and 50 in the high-risk HPV negative group.2、According to the proposed diagnostic classification of colposcopic images,70patients in the LSIL group and 397 patients in the HSIL group.Comparison between pseudodiagnosis by colposcopic images and final pathologic diagnosis:74.52%overall concordance,19.70%over-and 5.78%under diagnosis,50.00%(35/70)specificity90.89%in the LSIL group,78.84%(313/397)specificity 96.01%in the HSIL group.The compliance rate was compared between the two groups,X~2=26.268,P<0.01,which was statistically significant.3.According to the pathological results of cervical biopsy under colposcopy,58cases were normal and inflammatory group,7 cases were cervical cancer group,87 cases were LSIL group,315 cases were HSIL group.The overall coincidence rate was 93.15%;86%(44/58)in normal group and inflammation group,and 85.06%(74/87)in LSIL group;98.41%(310/315).The coincidence rate of LSIL group and HSIL group was compared,X~2=28.429,P<0.01,with statistical significance.4.Univariate analysis of the concordance rate of the proposed diagnosis by colposcopic images revealed that menopausal status,transformation zone,and high-risk HPV infection status were significant factors for the diagnosis of squamous intraepithelial neoplasia of the cervix by colposcopy.The diagnostic concordance was 82.70%,69.15%in the premenopausal and postmenopausal groups,respectively,X~2=10.808,P<0.01,statistically significant.The diagnostic concordance rates of transformed zone types Ⅰ,Ⅱ,and Ⅲ were 79.41%,76.25%,and 56.51%,respectively,with pairwise comparison,X~2(Ⅰ,Ⅱ)=0.454,P>0.01,not statistically significant;X~2(Ⅰ,Ⅲ)=16.525,P<0.01,statistically significant;X~2(Ⅱ,Ⅲ)=10.064,P<0.01,statistically significant.The diagnostic concordance rate of high-risk HPV16 and 18 positive group,high-risk HPV other subtype positive group and high-risk HPV negative group were 79.73%,66.38%and 62.00%,respectively,with pairwise comparison,X~2(16,18 positive group,other positive group)=8.192,P<0.01,statistically significant;X~2(16,18 positive group,high-risk negative group)=7.663,P<0.01,statistically significant;X~2(other positive group,high-risk negative group)=0.295,P>0.01,not statistically significant.5.Multivariate analysis of the coincidence rate of colposcopic images showed that:menopausal status,P<0.05,with statistical significance.transformation area,P<0.05,with statistical significance.high-risk HPV infection status,P<0.05,with statistical significance.Conclusion1.The coincidence rate of colposcopy image to be diagnosed as HSIL is higher than that of LSIL;The sensitivity of HSIL was high;The specificity was high when LSIL was diagnosed.2.The coincidence rate of cervical biopsy under colposcopy for HSIL was higher than that of LSIL.3.Menopausal status,transformation zone,and high-risk HPV infection status have an impact on the accuracy of colposcopic image preparation for the diagnosis of squamous intraepithelial lesions of the cervix.Menopausal status,transformation zone,and high-risk HPV infection status were all independent factors associated with the diagnosis of cervical squamous intraepithelial lesions by colposcopy.The accuracy of colposcopic images to diagnose squamous intraepithelial lesions of the uterine cervix is high when pre menopausal,type Ⅰ and Ⅱ transformation zone,high-risk hpv16,18 are positive.