Liu Y Y, Guo R X, Li B J, Wu Y, Bai J, Li L X, Wang C F
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Gynecological Cancer Prevention and Treatment Medicine, Zhengzhou 450052, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Feb 25;56(2):114-120. doi: 10.3760/cma.j.cn112141-20201010-00768.
To analyze the characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in postmenopausal women. A retrospective study was performed on 2 013 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by cervical conization at the First Affiliated Hospital of Zhengzhou University from June 2017 to November 2018, to compare the difference of patients' clinical features, HPV test, liquid-based thin-layer cytology (TCT), performance of colposcopy and biopsy pathology, pathology after cervical conization between 439 postmenopausal patients and 1 574 pre-menopausal patients. (1) Clinical features: the proportion of contact bleeding showed no significant difference between postmenopausal patients and pre-menopausal patients [4.3% (19/439) vs 6.4% (101/1 574); ²=2.672, =0.102]. Among the patients with contact bleeding, the proportion of cervical cancer after cervical cone resection was significantly higher in postmenopausal patients compared with pre-menopausal patients [10/19 vs 22.8% (23/101); ²=7.157, =0.007]. Among the patients found by routine screening, the proportion of cervical cancer after cervical cone resection was significantly higher in postmenopausal patients compared with pre-menopausal patients [9.0% (38/420) vs 4.3% (63/1 473); ²=14.726, <0.01]. The proportion of smooth cervix was higher in postmenopausal patients compared with pre-menopausal patients [63.6% (279/439) vs 35.5% (558/1 574); ²=111.601, <0.01]. (2) High-risk HPV infection: there was no significant difference in the high-risk HPV positive rate between the postmenopausal group and the pre-menopausal group [92.0% (404/439) vs 94.4% (1 486/1 574); ²=3.394, =0.065]; the HPV 16 infection was the most common type, but there was no significant difference in the HPV 16 infection rate between the two groups [65.8% (289/439) vs 68.0% (1 070/1 574); ²=0.722, =0.395]. (3) TCT test: TCT test results included negative for intraepithelial lesion and malignancy (NILM), atypical squamous cell of undetermined signification (ASCUS), atypical squamous cells cannot exclude high-grade lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), HSIL, compared with the different results of TCT examination, there were not statistically significant difference between postmenopausal and pre-menopausal patients (all >0.05). (4) The performance of colposcopy: the proportion of insufficient colposcopy and the proportion of cervical type Ⅲ conversion area were higher in postmenopausal patients compared with pre-menopausal patients [87.5% (384/439) vs 32.5% (511/1 574), <0.01; 80.0% (351/439) vs 21.9% (344/1 574), <0.01]. The proportion and positive rate of endocervical curettage (ECC) in postmenopausal patients were higher than those in pre-menopausal patients [35.3% (155/439) vs 20.4% (322/1 574), <0.01; 67.7% (105/155) vs 53.1% (171/322), =0.003]. The proportion of lesions involving the vaginal wall was higher in postmenopausal patients compared with pre-menopausal patients [5.9% (26/439) vs 1.0% (16/1 574); χ²=40.443, <0.01]. There was a positive correlation between vaginal wall lesions and cervical lesions in postmenopausal patients (=0.660, <0.01). (5) Postoperative pathology: the positive rate of margin and the proportion of pathological escalation after cervical conization were significantly higher in postmenopausal patients compared with pre-menopausal patients [14.6% (64/439) vs 4.8% (75/1 574), 10.9% (48/439) vs 5.5% (86/1 574); <0.01]. Colposcopy in postmenopausal women is often inadequate, and the cervix is mostly type Ⅲ transformation zone. The lesion in postmenopausal women is more likely to involve the cervical canal and vaginal wall. Clinical attention should be paid to cervical tube curettage and comprehensive examination of the vaginal wall. The high rate of positive margins and a high proportion of pathological upgrading after cervical conization in postmenopausal patients requires further active intervention.
分析绝经后妇女宫颈组织取样诊断的高级别鳞状上皮内病变（HSIL）的特征。对2017年6月至2018年11月在郑州大学第一附属医院经阴道镜下宫颈组织取样诊断为HSIL并行宫颈锥切术治疗的2013例患者进行回顾性研究，比较439例绝经后患者与1574例绝经前患者的临床特征、HPV检测、液基薄层细胞学检查（TCT）、阴道镜检查及活检病理表现、宫颈锥切术后病理情况的差异。（1）临床特征：绝经后患者与绝经前患者接触性出血比例差异无统计学意义[4.3%（19/439）对6.4%（101/1574）；χ²=2.672，P=0.102]。在接触性出血患者中，绝经后患者宫颈锥切术后宫颈癌比例显著高于绝经前患者[10/19对22.8%（23/101）；χ²=7.157，P=0.007]。在常规筛查发现的患者中，绝经后患者宫颈锥切术后宫颈癌比例显著高于绝经前患者[9.0%（38/420）对4.3%（63/1473）；χ²=14.726，P<0.01]。绝经后患者宫颈光滑比例高于绝经前患者[63.6%（279/439）对35.5%（558/1574）；χ²=111.601，P<0.01]。（2）高危型HPV感染：绝经后组与绝经前组高危型HPV阳性率差异无统计学意义[92.0%（404/439）对94.4%（1486/1574）；χ²=3.394，P=0.065]；HPV16感染最为常见，但两组HPV16感染率差异无统计学意义[65.8%（289/439）对68.0%（1070/1574）；χ²=0.722，P=0.395]。（3）TCT检查：TCT检查结果包括上皮内病变和恶性病变阴性（NILM）、意义不明确的非典型鳞状细胞（ASCUS）、不能排除高级别病变的非典型鳞状细胞（ASC-H）、低级别鳞状上皮内病变（LSIL）、HSIL，比较不同TCT检查结果，绝经后患者与绝经前患者差异无统计学意义（均P>0.05）。（4）阴道镜检查表现：绝经后患者阴道镜检查不满意比例及宫颈Ⅲ型转化区比例高于绝经前患者[87.5%（384/439）对32.5%（511/1574），P<0.01；80.0%（351/439）对21.9%（344/1574），P<0.01]。绝经后患者宫颈管搔刮术（ECC）比例及阳性率高于绝经前患者[35.3%（155/439）对20.4%（322/1574），P<0.01；67.7%（105/155）对53.1%（171/322），P=0.003]。绝经后患者病变累及阴道壁比例高于绝经前患者[5.9%（26/439）对1.0%（16/1574）；χ²=40.443，P<0.01]。绝经后患者阴道壁病变与宫颈病变呈正相关（r=0.660，P<0.01）。（5）术后病理：绝经后患者宫颈锥切术后切缘阳性率及病理升级比例显著高于绝经前患者[14.6%（64/439）对4.8%（75/1574），10.9%（48/439）对5.5%（86/1574）；P<0.01]。绝经后妇女阴道镜检查常不满意，宫颈多为Ⅲ型转化区。绝经后妇女病变更易累及宫颈管及阴道壁。临床应重视宫颈管搔刮及阴道壁全面检查。绝经后患者宫颈锥切术后切缘阳性率高及病理升级比例高，需进一步积极干预。
