Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization： a retrospective analysis

The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion （HSIL） patients with positive margin by conization. Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014. All patients underwent secondary conization or hysterectomy within 6 months. The rate of residual lesion was calculated, and the factors associated with residual lesion were analyzed by univariate and multivariate analyses. Among a total of 119 patients, 56 （47.06%） patients presented residual HSIL in their subsequent surgical specimens, including 4 cases of invasive cervical carcinoma （3 stage IA1 and 1 stage IA2 patients）. Univariate analysis showed that patient age 〉 35 years （P = 0.005）, menopausal period 〉 5 years （P = 0.0035）, and multiple- quadrant involvement （P=0.001） were significantly correlated with residual disease; however, multivariate analysis revealed that multiple-quadrant involvement （P=0.001; OR, 3.701; 95%CI, 1.496-9.154） was an independent risk factor for residua! disease. Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens, and those with multiple positive margins may consider re- conization or re-assessment.

Large pelvic mass arising from the cervical stump: A case report

BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.

宫颈锥切范围的临床研究

目的 探讨生育年龄女性因宫颈高级别鳞状上皮内病变行宫颈锥形切除术的适宜范围。方法 将98例因宫颈高级别鳞状上皮内病变行宫颈锥切术的有生育要求的生育年龄女性患者分成A、B组,A组51例,B组47例,两组各有2例阴道镜示不满意,转化区为3型。两组锥底宽度为碘不着色区外3~5 mm;A、B组锥切高度为10~15、16~25 mm。对两组手术时间、术中出血量、住院时间、切缘阳性率、术后晚期出血及宫颈粘连、治愈时间及术后3、6个月随访结果统计分析。结果 A、B组手术时间分别为（15±5.5）、（18±5.2）min,术中出血量分别为（20±9.5）、（28±10.5）ml（P〈0.001）,差异有统计学意义（P〈0.05）。A、B组住院时间分别为（2.0±0.64）、（2.0±0.73）d,差异无统计学意义（P〉0.05）。A组切缘阳性率3.9%（2例）,B组切缘阳性率2.1%（1例）,均为3型转化区患者,1个月后此3例再次宫颈补切后切缘转为阴性。术后2周左右,B组发生宫颈创面大出血1例,行缝扎止血;A组无大出血病例。两组无1例宫颈粘连或狭窄发生。术后4~5周随访结果显示：两组宫颈伤口均已痊愈,宫颈形状均恢复良好。术后3、6个月复诊,两组TCT均阴性,A组有2例（3.9%）HPV-DNA阳性,B组1例（2.1%）HPV-DNA阳性,差异均无统计学意义（P〉0.05）结论 患宫颈高级别鳞状上皮内病变的生育年龄女性,如宫颈转化区为1和2型,高度仅需10~15 mm的宫颈锥切术将有利于今后的妊娠结局,而3型转化区患者则需切除更深更多的组织方能保证切净病变组织。

Polarimetry feature parameter deriving from Mueller matrix imaging and auto-diagnostic signicance to distinguish HSIL and CSCC

High-grade squamous intraepithelial lesion(HSIL)is regarded as a serious precancerous state of cervix,and it is easy to progress into cervical invasive carcinoma which highlights the importance of earlier diagnosis and treatment of cervical lesions.Pathologists examine the biopsied cervical epithelial tissue through a microscope.The pathological examination will take a long time and sometimes results in high inter-and intra-observer variability in outcomes.Polarization imaging techniques have broad application prospects for biomedical diagnosis such as breast,liver,colon,thyroid and so on.In our team,we have derived polarimetry feature parameters(PFPs)to characterize microstructural features in histological sections of breast tissues,and the accuracy for PFPs ranges from 0.82 to 0.91.Therefore,the aim of this paper is to distinguish automatically microstructural features between HSIL and cervical squamous cell carcinoma(CSCC)by means of polarization imaging techniques,and try to provide quantitative reference index for patho-logical diagnosis which can alleviate the workload of pathologists.Polarization images of the H&E stained histological slices were obtained by Mueller matrix microscope.The typical path-ological structure area was labeled by two experienced pathologists.Calculate the polarimetry basis parameter(PBP)statistics for this region.The PBP statistics(stat PBPs)are screened by mutual information(MI)method.The training method is based on a linear discriminant analysis(LDA)classier whichnds the most simplied linear combination from these stat PBPs and the accuracy remains constant to characterize the specic microstructural feature quantitatively in cervical squamous epithelium.We present results from 37 clinical patients with analysis regions of cervical squamous epithelium.The accuracy of PFP for recognizing HSIL and CSCC was 83.8%and 87.5%,respectively.This work demonstrates the ability of PFP to quantitatively charac-terize the cervical squamous epithelial lesions in the H&E pathological sections.Signicance:Polarization detection technology provides an effcient method for digital pathological diagnosis and points out a new way for automatic screening of pathological sections.