Study on the relationship between colposcopy findings and the progression of cervical intraepithelial neoplasia and the analysis of missed diagnosis factors in the evaluation of high-grade lesions
- VernacularTitle:阴道镜表现与宫颈上皮内瘤变进展的关系及对高级别病变评估漏诊的因素分析
- Author:
Huichun CAI
1
Author Information
- Publication Type:Journal Article
- Keywords: cervical intraepithelial neoplasia(CIN); high-grade lesions; colposcope; missed diagnosis
- From: China Journal of Endoscopy 2025;31(5):32-40
- CountryChina
- Language:Chinese
- Abstract: Objective To investigate the relationship between colposcopy findings and the progression of cervical intraepithelial neoplasia(CIN)and analyze the factors of missed diagnosis in the evaluation of high-grade lesions.Methods 304 cases who underwent colposcopy-guided biopsy and were diagnosed with CIN from January 2020 to November 2023 were selected.Based on colposcopic biopsy results,patients were classified into CIN Ⅰ(103 cases),CIN Ⅱ(137 cases),CIN Ⅲ(59 cases),and early invasive carcinoma(5 cases).By comparing with postoperative pathological results from loop electrosurgical excision procedure of cervix(LEEP of cervix),high-grade cases(CIN Ⅱ and above)were further subdivided into the detected group and the missed diagnosis group.Logistic regression analysis was performed to identify factors influencing the underdiagnosis of high-grade CIN by colposcopy.Results Abnormal blood vessels and acetowhite epithelium observed during colposcopy were helpful in differentiating various grades of CIN.Although the overall concordance rate of CIN diagnosis by colposcopy-guided biopsy was relatively high,21 cases of high-grade CIN(including 14 CIN Ⅱ,5 CIN Ⅲ,and 2 early invasive carcinoma)were missed.Factors independently associated with the underdiagnosis of high-grade CIN included parity,menopause,non-staining areas with iodine<2 cm,cytological examination of low-grade squamous intraepithelial lesion(LSIL),lesion size<1/2,single biopsy specimen,and poor-quality colposcopic images(P<0.05).Conclusion Colposcopic biopsy shows a high concordance rate for diagnosing CIN across different grades.However,parity,menopause,non-staining areas with iodine<2 cm,cytological examination of LSIL,lesion size<1/2,single biopsy specimen,and colposcopic image poor-quality are identified as independent factors influencing the underdiagnosis of high-grade CIN.These factors should be considered in clinical practice to improve diagnostic accuracy.
