Analysis of related factors for cervical intraepithelial neoplasia Ⅱ + detection in grade 1 abnormal colposcopic finding of cervix / 中华妇产科杂志

ABSTRACT

Objective:To screen out high risk factors of cervical intraepithelial neoplasia (CIN) of grade Ⅱ or worse (CIN Ⅱ +) by analyzing related factors for CIN Ⅱ + detection in grade 1 abnormal colposcopic finding (G1) of cervix and provide reference for individual management of colposcopic performance. Methods:A retrospective study was performed on patients who were reffered to colposcopy for abnormal results of cervical cancer screening and only had G1 colposcopic findings of cervix at the First Affiliated Hospital of Nanjing Medical University, from April 2017 to January 2021. The factors influencing the detection of CIN Ⅱ + were analyzed by univariate and multivariate analysis. Results:(1) A total of 403 patients were included in this study whose median age was 38 years old (range 22-67 years old), and utimately 108 had high-grade squamous intraepithelial lesion, 1 had adenocarcinoma in situ and 1 had adenocarcinoma. The overall detection rate of CIN Ⅱ + was 27.3% (110/403). (2) Univariate analysis showed that the detection rate of CIN Ⅱ +, in patients ≥50 years old was higher than that in patients <50 years old (38.3% vs 25.4%; χ2=4.328, P=0.037), and in HPV 16 positive cases was higher than that in non-HPV 16 positive cases (41.8% vs 21.8%; χ2=16.080, P<0.01); as the cytological severity ( χ2=6.775, P=0.009) and the number of involving quadrants ( χ2=31.117, P<0.01) increased, the risk of CIN Ⅱ + detection increased; but the types of colpolscopic signs were not related to detection of CIN Ⅱ +( χ2=0.323, P=0.851). Multivariable analysis showed that the age of ≥50 years old ( OR=2.504, 95% CI 1.299-4.830, P=0.006), HPV 16 positive type ( OR=3.353, 95% CI 2.004-5.608, P<0.01) and the increase of involving quadrants ( OR=1.899, 95% CI 1.518-2.376, P<0.01) were independent risk factors. (3) The detection rate of CIN Ⅱ + was highest in the women with HPV 16 positive type and four quadrants of G1 (73.7%), while lowest in the women with non-HPV 16 positive type and one quadrant of G1 (10.4%). Conclusions:The age of ≥50 years old, HPV 16 positive type and the increase of involving quadrants are independent risk factors of detecting CIN Ⅱ + in G1 colposcopic findings. So the key point of the individual management of G1 groups with different risk stratification is to adequately biopsy in high-risk group to avoid miss diagnosis of CIN Ⅱ +.