The accuracy of diagnosing cervical intraepithelial neoplasia with colpscopically directed biopsy and the related factors of the missed diagnosis of cervical invasive carcinoma

Objective: To evaluate the accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia(CIN),and to analyze the related factors of missed diagnosis of cervical invasive carcinoma.Methods: In this case-control study within three years,315 patients with CIN,diagnosed definitely by colposcopically directed biopsy and treated with cervical loop electrosurgical procedure(LEEP) shortly after being diagnosed,were retrospectively analyzed.And the accuracy of colposopical biopsy was evaluated.Multivariate logistic regression was applied to analyzing the data of patients' age,infected Hr-HPV,cytological diagnosis,grade of pathology,unsatisfactory colposcopy,the number of the samples so as to understand the related factors of the missed diagnosis of cervical invasive carcinoma.Results: Of the 315 patients,the diagnosis accordance rate of colposcopically directed biopsy and LEEP was 69.21%,overdiagnosis rate was 17.14%,underdiagnosis rate was 13.65%,including 23 cases of cervical invasive carcinoma which accounted for 7.3%.Based on the monovariate logistic regression analysis,the analyzed related factores of the missed diagnosis of cervical invasive carcinoma under the colpscopically directed biopsy showed that HSIL in cytological diagnosis,unsatisfactory colposcopy and only one biopsy sample were selected into the module,whose OR value was 8.163,4.209 and 4.012 respectively.Conclusions: The accuracy of diagnosing CIN with lolposcopically directed biopsy is still unsatisfactory,especially,the cervical carcinoma may be missed.And attention should be paid to the patients whose HSIL results in cytological diagnosis,unsatisfactory colposcopy and only one biopsy sample because these factors are more likely to result in cervical carcinoma.