绝经后女性子宫颈高级别鳞状上皮内病变术后病理诊断升级临床病理分析

Clinicopathological analysis of postoperative pathological diagnosis upgrade of post-menopausal high-grade cervical squamous intraepithelial lesions in women

目的探讨绝经后女性子宫颈高级别鳞状上皮内病变(HSIL)术后病理诊断升级情况及其影响因素。方法回顾性分析2017年1月至2021年12月在山西白求恩医院接受子宫颈锥切或全子宫切除术治疗的387例绝经后女性HSIL患者的临床病理资料。根据术后病理诊断是否升级为癌分为升级组和未升级组, 比较两组临床病理特征, 采用多因素logistic回归分析术后病理升级的影响因素。结果 387例患者中, 术后病理升级为癌者28例(7.2%)。与未升级组相比, 升级组子宫颈液基薄层细胞学检查(TCT)为HSIL的比例[57.1%(16/28)比44.6%(160/359)]、阴道镜印象为HSIL的比例[89.3%(25/28)比59.3%(213/359)]、病变累及腺体的比例[46.4%(13/28)比24.0%(86/359)]、病变累及点数≥2个的比例[82.1%(23/28)比59.6%(214/359)]、子宫颈管搔刮术(ECC)阳性的比例[64.3%(18/28)比46.0%(165/359)]均高, 差异均有统计学意义(均P<0.05);两组间按绝经期持续时间、阴道出血、孕次、产次、人乳头瘤病毒(HPV)16/18感染、多重HPV感染分层患者比例差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示, 阴道镜印象为HSIL(OR=6.195, 95%CI 1.432~26.804)、病变累及腺体(OR=2.468, 95%CI 1.050~5.801)、ECC阳性(OR=3.477, 95%CI 1.028~11.764)是绝经后女性HSIL患者术后病理升级为癌的独立危险因素(均P<0.05)。结论对于绝经后女性, 当患者阴道镜印象为HSIL、病变累及腺体及ECC阳性者需警惕术后病理升级的风险。

Objective To investigate postoperative pathological diagnosis upgrade of high-grade cervical squamous intraepithelial lesions(HSIL)in postmenopausal women and its influencing factors.Methods Clinicopathologic data of 378 post-menopausal women with HSIL who underwent cervical conization or total hysterectomy in Shanxi Bethune Hospital between January 2017 and December 2021 were retrospectively analyzed.According to whether the pathological diagnosis was upgraded after operation,they were divided into upgraded group and non-upgraded group.The clinicopathological characteristics of both groups were compared.Multivariate logistic regression was used to analyze the influencing factors of postoperative pathological upgrade.Results Among 387 patients,28 patients(7.2%)were postoperatively upgraded to cervical cancer.Compared with the non-upgraded group,the proportions of the following indexes in the upgraded group were higher[the proportion of HSIL detected by cervical thinprep cytologic test(TCT):57.1%(16/28)vs.44.6%(160/359);the proportion of HSIL detected by colposcopic impression:89.3%(25/28)vs.59.3%(213/359);the proportion of glandular involvement:46.4%(13/28)vs.24.0%(86/359);the number of lesion involvement≥2:82.1%(23/28)vs.59.6%(214/359);the proportion of positive endocervical curettage(ECC):64.3%(18/28)vs.46.0%(165/359)];and the differences were statistically significant(all P<0.05).There were no statistically significant differences in the proportions of patients stratified by menopausal duration,colporrhagia,gravidity frequency,reproductive frequency,human papillomavirus(HPV)16/18 infection and multiple HPV infection(all P>0.05).Multivariate logistic analysis found that colposcopic impression of HSIL(OR=6.195,95%CI 1.432-26.804),glandular involvement(OR=2.468,95%CI 1.050-5.801),and ECC positive(OR=3.477,95%CI 1.028-11.764)were independent risk factors for postoperatively upgraded to cancer for postmenopausal HSIL patients in women(all P<0.05).Conclusion For post-menopausal women,patients with colposcopic impression of HSIL,glandular involvement and ECC positive should be alert to the risk of postoperatively pathological upgrade.