Xin yixue (Dec 2023)
Analysis of high risk factors of pathological escalation after LEEP in CIN2 diagnosed by colposcopic biopsy
Abstract
Objective To investigate the risk factors associated with pathological escalation to cervical intraepithelial neoplasia grade 2 （CIN2） or above （CIN2+） in patients with CIN2 confirmed by colposcopic biopsy， aiming to provide evidence for the stratified management of CIN2 patients. Methods Clinical data of 210 patients who underwent LEEP surgery after pathological diagnosis of cervical CIN2 by colposcopic biopsy were retrospectively analyzed. Pathological diagnosis of patients before and after LEEP surgery was observed. The relationship between pathological escalation after LEEP， and age，results of primary liquid-based thin-layer cytology （TCT）， typing of high-risk human papillomavirus （HPV）， the number of affected quadrants of lesions under colposcopy， the proportion of visible lesion area to cervical surface area， the longest linear length of the lesion， the type of transformation zone （TZ）， whether the lesion was involved with glands and the characteristics of colposcopic images was assessed by univariate and multivariate Logistic regression analyses. Results Among 210 cases of cervical CIN2 diagnosed by colposcopic biopsy， 37 cases （17.6%） were pathologically diagnosed with CIN2+ after LEEP， and 1 case was diagnosed with cervical squamous cell carcinoma stage IB1. Univariate analysis showed that pathological escalation after LEEP was associated with the age of patients， the number of affected quadrants of lesions under colposcopy， the proportion of visible lesion area to cervical surface area， the longest linear length of visible lesions， the type of transformation zone，and the characteristics of colposcoic images （all P < 0.05）. Multivariate analysis showed that the number （>1） of affected quadrants of lesions under colposcopy，the proportion （≥1/3） of visible lesion area to cervical surface area， TZ3 type and the characteristics （≥2） of colposcopic images were the high-risk factors for pathological escalation after LEEP （all P < 0.05）. For patients aged 26-50 years， the proportion （≥1/3） of lesion area to cervical surface area， TZ3 type and the characteristics （≥2） of colposcopic images were the high-risk factors for pathological escalation after LEEP （all P < 0.05）. Conclusions Colposcopic biopsy may miss the diagnosis of CIN2+ in patients diagnosed with CIN2. The risk of missing the diagnosis of CIN2+ is increased with the increase of the proportion of visible lesion area to cervical surface area （>1/3）， the invisibility of the squamous-column junction under colposcopy，and the proportion of grade 2 signs in colposcopic images （≥2）. For patients with CIN2 who are willing to have children，if they have the above high-risk factors，it is recommended to carefully deliver follow-up observation.
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