Mao Y N, You Z X
Department of Obstetrics and Gynecology, the First Clinical Medical College, Nanjing Medical University, Nanjing 210029, China.
Department of Gynecology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Zhonghua Fu Chan Ke Za Zhi. 2021 Oct 25;56(10):691-696. doi: 10.3760/cma.j.cn112141-20210809-00434.
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. 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. (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%; ²=4.328, =0.037), and in HPV 16 positive cases was higher than that in non-HPV 16 positive cases (41.8% vs 21.8%; ²=16.080, <0.01); as the cytological severity (²=6.775, =0.009) and the number of involving quadrants (²=31.117, <0.01) increased, the risk of CIN Ⅱ detection increased; but the types of colpolscopic signs were not related to detection of CIN Ⅱ(²=0.323, =0.851). Multivariable analysis showed that the age of ≥50 years old (=2.504, 95%: 1.299-4.830, =0.006), HPV 16 positive type (=3.353, 95%: 2.004-5.608, <0.01) and the increase of involving quadrants (=1.899, 95%: 1.518-2.376, <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%). 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.
通过分析宫颈阴道镜检查1级异常（G1）中宫颈上皮内瘤变Ⅱ级及以上（CINⅡ）的相关因素，筛选出CINⅡ的高危因素，为阴道镜检查的个体化管理提供参考。对2017年4月至2021年1月在南京医科大学第一附属医院因宫颈癌筛查结果异常而接受阴道镜检查且仅具有宫颈G1阴道镜检查结果的患者进行回顾性研究。通过单因素和多因素分析影响CINⅡ检出的因素。（1）本研究共纳入403例患者，中位年龄为38岁（范围：22 - 67岁），最终108例为高级别鳞状上皮内病变，1例为原位腺癌，1例为腺癌。CINⅡ的总体检出率为27.3%（110/403）。（2）单因素分析显示，年龄≥50岁患者的CINⅡ检出率高于<50岁患者（38.3%对25.4%；χ² = 4.328，P = 0.037），HPV 16阳性病例的检出率高于非HPV 16阳性病例（41.8%对21.8%；χ² = 16.080，P < 0.01）；随着细胞学严重程度（χ² = 6.775，P = 0.009）和累及象限数（χ² = 31.117，P < 0.01）增加，CINⅡ检出风险增加；但阴道镜征象类型与CINⅡ检出无关（χ² = 0.323，P = 0.851）。多因素分析显示，年龄≥50岁（β = 2.504，95%CI：1.299 - 4.830，P = 0.006）、HPV 16阳性类型（β = 3.353，95%CI：2.004 - 5.608，P < 0.01）和累及象限数增加（β = 1.899，95%CI：1.518 - 2.376，P < 0.01）是独立危险因素。（3）HPV 16阳性类型且G1累及四个象限的女性中CINⅡ检出率最高（７３.７%），而非HPV 16阳性类型且G1累及一个象限的女性中最低（10.4%）。年龄≥50岁、HPV 16阳性类型和累及象限数增加是G1阴道镜检查结果中检出CINⅡ的独立危险因素。因此，对不同风险分层的G1组进行个体化管理的关键是对高危组进行充分活检，以避免漏诊CINⅡ。
