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Objective To explore the detection trend of vaginal intraepithelial neoplasia(VaIN)of lower genital tract from 2013 to 2015. Methods A retrospective analysis was undertaken of colposcopy-directed biopsy of cervical, vaginal and vulvar intraepithelial neoplasia lesions include cervical intraepithelial neoplasia (CIN), VaIN and vulvar intraepithelial neoplasia (VIN) in Obstetrics and Gynecology Hospital of Fudan University from January 2013 to December 2015. Results (1) Overall data of CIN, VaIN and VIN:a total of 16732 cases were diagnosed of lower genital intraepithelial neoplasia in 3 years, accounting for 23.20% (16732/72128) of total colposcopy-directed biopsy cases. Among them, CIN, VaIN and VIN accounted for 19.48%(14053/72128), 2.67%(1923/72128), 1.05%(756/72128) of total colposcopy-directed biopsy cases of the lower genital tract, 83.99%(14053/16732), 11.49%(1923/16732), 4.52%(756/16732) of total lower genital intraepithelial neoplasia, respectively. (2) Annual data of CIN, VaIN and VIN from 2013 to 2015. The annual proportion of CIN in all intraepithelial neoplasia of lower gential tract was basically stable, consisting of 86.02%(3955/4598),83.25%(4795/5760) and 83.20%(5303/6374), respectively. The annual proportion of VaIN was gradually increasing, consisting of 8.09% (372/4598), 12.45%(717/5760) and 13.08%(834/6374), respectively. The annual proportion of VIN was gradually decreasing, consisting of 5.89% (271/4598), 4.31% (248/5760) and 3.72% (237/6374), respectively. Conclusion The increasing detection of VaIN from 2013 to 2015 might correlate with the increasing attention to inspection of the entire vaginal wall.
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Objective To explore the sensitivity and specificity of colposcopy directed biopsy (CDB) and the value of loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of microinvasive cervical cancer (MCC). Methods One hundred and thirty five patients with MCC were diagnosed with LEEP in Obstetrics and Gynecology Hospital, Fudan University from April 2008 to November 2010, and were retrospectively analyzed on CDB diagnoses and following treatment after LEEP. According to patient′s desire for preservation of fertility and cone margin status, following strategies after LEEP included follow-up, second LEEP, hysterectomy, modified radical hysterectomy and radical hysterectomy. Single and multiple factors related to residual lesions after LEEP were analysed with Pearson Chi-square test and logistic regression model, respectively. Results CDB diagnosed MCC with a sensitivity of 4.4%(6/135), specificity of 100.0%(4 680/4 680), and false negative rate of 95.6%(129/135). Among the 135 patients, 29 did not receive further treatment in our hospital and lost contact. One hundred and six patients had secondary treatment or follow-up in our hospital, 4 of among which were closely followed up;one hundred and two received further treatment, which included 6 cases with second LEEP (3 received extrafascial hysterectomy after repeat LEEP), 59 cases hysterectomy, 14 cases modified radical hysterectomy and 26 cases radical hysterectomy. For factors related to residual lesions after LEEP, single factor analysis showed that the ratio of residual lesion in patients aged 27-39, 40-49 and 50-65 years were respectively 19.0%(11/58), 15.4%(10/65) and 5/12 (χ2=4.505, P=0.105). Residual lesions occurred in 24.7%(23/93) of patients with positive LEEP margins, which was more than that 7.1%(3/42) of patients with negative LEEP margins (χ2=5.756, P=0.016). The ratio of residual lesions in patients with positive endocervical, ectocervical and deep stromal margins were respectively 29.6%(8/27), 17.1%(7/41)and 30.6%(11/36;χ2=2.275, P=0.321). Residual lesions in patients with or without lymph vascular space invasion (LVSI) were 2/7 and 18.8%(24/128), respectively (χ2=0.412, P=0.521). The ratio of residual lesions in patients with invasion depth of<1 mm was 17.1%(7/41), 1-<3 mm was 19.0%(16/84), and 3-5 mm was 3/10, with no significant difference among three groups (χ2=0.870, P=0.647). Logistic regression analysis showed positive cone margin (OR=5.069, P=0.014) and age (OR=1.080, P=0.024) were the independent risk factors of residual lesions after LEEP conization. Conclusions CDB alone is not adequate for the diagnosis of MCC. For young patients who desire to preserve fertility with a negative cone margin, close follow-up is acceptable. Cone margin status and age are two independent risk factors for residual lesions after LEEP.
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Objective To evaluate the agreement between colposcopic diagnosis with 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy (IFCPC) and cervical pathology in cervical lesions. Methods A retrospective cohort study was performed, which included 376 patients who underwent colposcopy with 2011 international terminology of colposcopy at Obstetrics and Gynecology Hospital of Fudan University from September 2014 to November 2014. With conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated and correlations between variables were analyzed. Results With 2011 international terminology of colposcopy, agreement of colposcopic diagnosis and cervical pathology was 60.9%(229/376)perfectly matched, and the strength of agreement with weighted Kappa statistic was 0.401 (P<0.01), and agreement within one grade was 97.6%(367/376), which were improved compared with traditional methods. Colposcopic diagnosis were 19.9%(75/376) overestimated and 19.1%(72/376) underestimated. There were no significant difference between agreements in various grade lesions (χ2=1.996, P=0.573). Positive predictive value of high grade colposcopy or more was 84.4%, the negative predictive value of low grade colposcopy or less was 88.8%, whereas false positives were 3.5%and false negatives were 39.3%. A linear trend among three types of transformation zone and patient ages was found (χ2=45.910, P<0.01), whereas lesion sizes were not linearly correlated with lesion degrees (χ2=0.690, P=0.406). In grade 1, grade 2 and nonspecific findings, thin acetowhite epithelium, dense acetowhite epithelium and Lugol′s non-staining were most frequent, the Youden indexes of each were 0.170, 0.373 and 0.145, 0.069 respectively. Positive predictive value of some other findings (such as fine mosaic) and two new signs (inner border sign and ridge sign) were 100.0%. There were no significant difference between agreements in examiners with different levels of experience (χ2=1.197,P=0.550). Conclusions Compared to traditional methods (such as Reid index), 2011 international terminology of colposcopy could improve the agreement between colposcopic diagnosis and pathologic diagnosis, without significant differences by the severity of lesion and the level of examiners′experience. Common findings were classified reasonably, and some signs were highly reliable, which is important for guiding biopsy. However, the reproducibility of transformation zone types and the implication of lesion size need to be further discussed.
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Objective To explore the clinical effects of hysteroscopy combined with mifepristone on the diagnosis and treatment of abortive remnants.Methods A total of 56 patients with abortive remnants,who had undergone uterine curettage after the abortion,were treated with mifepristone combined with hysteroscopy.Before hysteroscopy,mifepristone was taken orally at a dose of 100 mg daily(50 mg,Bid) for 7 days.After the surgery,those who still had remnants in the uterus were given mifepristone at the same dose for 14 days.Results No patient had complication during and after the hysteroscopy except for one,who had abortive remnants at the uterine horn,experienced blood loss of 200 ml.In 40 patients,the abortive remnants were removed completely by hysteroscopy.Two weeks after the surgery,laboratory examination of the patients showed normal blood ?-hCG,and B-ultrasonography revealed no space-occupying mass in the uterus.In the other 16 patients,remnants were detected in the uterine horns after the hysteroscopy,and mifepristone was prescribed.These patients received reexaminations 2 months after the operation,and no abnormal blood ?-hCG or remnants in the uterus was found.Among the 56 patients,33 were followed up for 1-6 months(mean,3 months).During the follow-up,their symptoms including vaginal bleeding or drainage,amenorrhea,and abdominal pain disappeared,and the menstruation became normal.Conclusions Hysteroscopy combined with mifepristone is an effective measure to diagnose and treat abortive remnants.
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Objective To evaluate advantages and safety of bipolar electrodes for the treatment of submucosal myoma of uterus.Methods Three hundred patients with submucous myoma of uterus were performed with bipolar electrodes under hysteroscope,including 212 cases of type 0 submucous myoma,54 cases of type ?,and 34 cases of type Ⅱ.Results Total volumes of uterine distention fluid used during operation were 500-2000 ml(mean,626 ml);operation time was 20-50 min(mean,25 min);intraoperative blood loss was 10-20 ml.Cardio-cerebral syndrome occurred in one case and was relieved by timely treatment.There was no operation discontinuation as a consequence of pain.The diameters of resected myomas were 3-5 cm,with an average of 3.8 cm.The postoperative diagnosis showed leiomyosarcoma in 1 case and was performed by radical hysterectomy resection combined with a pelvic lymphadenectomy at 10 day postoperatively.During the follow-up period of 1-24 months in 277 cases,40 cases(type I in 12 cases;type II in 28 cases) needed hysteroscope operation again.Conclusions Hysteroscopic resection for submucosal myoma of uterus with dipolar electrodes has advantages of safety,minimal invasion,quicker recovery,higher efficiency,so it is worthy of being recommended.