Accuracy of colposcopic cervical biopsy in the diagnosis of cervical precancerous lesions and analysis of influencing factor for missed diagnosis of cervical cancer

Jing CHEN; Yujie CHEN; Wenjuan YI

ABSTRACT

Objective:

To investigate the accuracy of colposcopic cervical biopsy in the diagnosis of cervical precancerous lesions and the factors of missed diagnosis of cervical cancer.

Methods:

A total of 327 cases of gynecological clinic in Liuzhou people's Hospital of Guangxi Zhuang Autonomous Region from January 2018 to May 2019 were selected. All patients underwent colposcopic biopsy and were histologically diagnosed as cervical intraepithelial neoplasia (CIN) Ⅰ, CIN Ⅱ, CIN Ⅲ, chronic cervicitis, cervical carcinoma in situ, and condyloma plana or condyloma-like change. The loop electrosurgical excision procedure (LEEP) was performed for treatment and pathological examination after operation was done. The results of pathological examination after colposcopic cervical biopsy and LEEP operation were compared. Univariate and multivariate logistic regression analysis was performed on the factors affecting missed diagnosis of cervical cancer by colposcopic cervical biopsy.

Results:

The diagnostic accuracy of colposcopic cervical biopsy for chronic cervicitis was 59.70% (40/67), for condyloma plana or condyloma-like lesions was 51.58% (49/95), for CINⅠ diagnosis was 85.14% (63/74), for CINⅠ, CINⅢ and carcinoma in situ was 73.63% (67/91). A total of 219 patients were consistent with the postoperative pathological results of LEEP, and the total diagnostic accuracy rate was 66.97% (219/327). The postoperative pathological results showed that there were 43 patients (13.15%) with acatalepsia and 48 patients (14.68%) with excessive diagnosis. The results of multivariate logistic regression analysis showed that the area of cervical lesions <50% of the cervix area, unsatisfactory colposcopy image quality, and the patient's age ≥50 years old were independent influencing factors for missed diagnosis of cervical cancer (all P < 0.05).

Conclusions:

Cervical biopsy under colposcopy has a certain inaccuracy in the diagnosis of cervical precancerous lesions, and it is prone to missed diagnosis of cervical cancer. Clinicians should improve the skills of colposcopy operation, and pay attention to the examination of elderly women and patients with unsatisfactory colposcopy images in order to further reduce the missed diagnosis rate of cervical cancer.