ABSTRACT
Objective To explore the value of histopathologic diagnosis after colposcopy for high-risk HPV16/18 positive patients with negative cytology or atypical squamous cells of undetermined significance (ASCUS) for early screening of cervical lesions. Methods A retrospective study of cervical histopathologic diagnosis in the HPV16/18 positive patients received colposcopy evaluation before got the histology was carried out between January 2014 and January 2016. The cytology of the patients should be negative or ASCUS. A total of 337 patients with age from 21 to 65 years old were enrolled, including 214 patients with negative cytology, and 123 patients with ASCUS. Results (1) The results of pathology were as follows: 63 (18.7%) cases inflammation, 89 (26.4%) cases cervical intraepithelial neoplasia (CIN)Ⅰ, 182 (54.0%) cases CINⅡ-Ⅲ and adenocarcinoma in situ (AIS), and 3 (0.9%) cases minimal invasive cancer (stage Ⅰa1). The incidence of CIN Ⅱ and above cervical lesions was higher in the patients with ASCUS (71.5%, 88/123) than that in the patients with negative cytology (45.3%, 97/214; χ2=24.876, P<0.01),and it was higher in the patients with HPV16 positive (64.4% , 150/233) than that in the patients with HPV18 positive (30.3% , 27/89; χ2=31.388, P<0.01). There was statistically significant difference among the different age group in which the patients of 20- 29 years old was 69.3% (52/75), 30- 39 years old was 55.1% (75/136), 40-49 years old was 44.8% (30/67) and 50 years old and above was 47.5% (28/59; χ2=16.512, P=0.032). (2) Among the patients with negative cytology, the incidence of CINⅡ and above cervical lesions in the patients with HPV16 positive was higher than that in the patients with HPV18 positive [54.8%(80/146)vs 26.0%(20/77);χ2=16.930, P<0.01]. The incidence was also higher in the patients with HPV16 positive than that in the patients with HPV18 positive [76.5%(78/102)vs 55.6%(15/27);χ2=4.642, P=0.031] among the patients with ASCUS. (3) Compared to the patients diagnosed inflammation or CINⅠ, the patients diagnosed CINⅡ and above cervical lesions had higher infection rate of HPV16, lower infection rate of HPV18, higher incidence of ASCUS, and smaller parities (all P<0.05). A multifactor analysis was carried out, the results showed that HPV16 positive and ASCUS might be independent risk factors to predict the incidence of CIN Ⅱ and above cervical lesions(P<0.01). Conclusions The incidence of cervical precancerous lesions is high in the women with HPV16/18 infection. Patients with HPV16 infection are more likely to have the CIN Ⅱ and above cervical lesions than patients with HPV18 infection. Patients with HPV16/18 infection are suggested to be directly transferred to clinic of colposcopy, and then getting the histology selectively, which would be help to early detection of the cervical precancerous lesions.
ABSTRACT
Objective To study the accuracy and efficiency of video colposcopy in diagnosis of cervical squamous intraepithelial lesions and clinical significance of seven colpocopic signs. Methods Two handred and senventy five patients with an abnormal cervical smear or vulva condyloma acuminata were re evaluated by video colposcopy. 265 cervical biopsies performed under the guidance of video colposcopy for pathological study, as well 8 endocervical curettage (ECC) and 237 loop electrosurgical excision procedure (LEEP). Results The sensitivity, specificity and positive rate of video colposcopy in evaluation of cervical squamous intraepithelial lesions were 95 9%, 77 7%, and 84 5%. Video colposcopy diagnostic accuracy was 93 8% tally with the pathological results in observing normal transformation zone. False negative rate was 6 1%. 76 2% of cases with subclinical papillomavirus infection by acetowhite epitheliun, while false negative rate was 23 7%. Twin signs, triple signs and cervical carcinoma were 100 0% tallying with the diagnosis of cervical lesions. Conclusions Video colposcopy can be a very accurate diagnostic method in clinical practice. It is quite sensitive in diagnosis of severe cervical lesions. However, there was a relative high false negative rate in diagnosing mild cervical lesions.