Analysis of influencing factors for underdiagnosis of high-grade squamous intraepithelial lesion of the uterine cervix and cervical cancer by colposcopy
10.3760/cma.j.cn115355-20230702-00344
- VernacularTitle:子宫颈高级别鳞状上皮内病变及子宫颈癌阴道镜检查漏诊影响因素分析
- Author:
Jiarong LI
1
;
Shuling WANG
;
Weihong ZHAO
Author Information
1. 山西医科大学公共卫生学院，太原 030001
- Keywords:
Uterine cervical neoplasms;
Squamous intraepithelial lesion of the uterine cervix;
Colposcopy;
Underdiagnosis
- From:
Cancer Research and Clinic
2023;35(11):822-826
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the influencing factors for underdiagnosis of high-grade squamous intraepithelial lesion (HSIL) of the uterine cervix and cervical cancer by colposcopy.Methods:The clinical data of 957 patients who underwent colposcopy and were diagnosed as HSIL or cervical cancer by histopathology at the Second Hospital of Shanxi Medical University from January 2017 to June 2022 were retrospectively analyzed, and logistic regression was used to analyze the influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy.Results:The results of univariate analysis showed that the underdiagnosis of HSIL and cervical cancer by colposcopy was related to whether or not menopause was present, whether or not there was coitus bleeding, whether or not there was irregular bleeding, liquid-based thin-layer cytology test (TCT) results, the morphology of the uterine cervix, the results of acetowhitening test, the results of iodine test, whether or not there was cuffed crypt (gland) openings, whether or not there was mosaicism, whether or not there was punctate vessels, whether or not the transformed zone was completely visible, the type of transformed zone, and whether or not the lesions involved the glands (all P < 0.05), but the underdiagnosis didn't related to whether or not there was human papillomavirus (HPV) infection, whether or not there was high-risk HPV multiple infections and the results of endocervical curettage (all P > 0.05). The results of multivariate logistic regression analysis showed that irregular bleeding ( OR = 4.279, 95% CI 2.170-8.441, P < 0.001), atypical squamous cells of uncertain significance (ASC-US) by TCT ( OR = 0.415, 95% CI 0.226-0.761, P = 0.004), atypical squamous cells, cannot exclud high-grade squamous intraepithelial lesion (ASC-H)/HSIL by TCT ( OR = 0.389, 95% CI 0.206-0.735, P = 0.004), thick acetowhite epithelium by acetowhitening test ( OR = 0.015, 95% CI 0.004-0.055, P < 0.001), and punctate vessels ( OR = 0.327, 95% CI 0.173-0.616, P = 0.001) were independent influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy. Conclusions:A history of irregular bleeding is a risk factor for underdiagnosis of HSIL of the uterine cervix and cervical cancer by colposcopy, while TCT results of ASC-US, ASC-H/HSIL and colposcopic visualization of thick acetowhite epithelium and punctate vessels could reduce the risk of underdiagnosis
