Re-evaluation of cervical intraepithelial neoplasia I diagnosed by colposcopic biopsy by loop electrosurgical excision procedure

Objective:To reevaluate mild cervical intraepithelial neoplasia(CIN) diagnosed by colposcopic biopsy by loop electrosurgical excision procedure(LEEP),compare infection of high risk human papillomavirus(HR-HPV) of different pathological types and detection results of Thinprep cytological test(TCT),evaluate the accuracy and comprehensiveness of colposcopic biopsy in diagnosis of CIN Ⅰ.Methods:The cases with cervical diseases visiting the hospital from January 2007 to November 2009 were selected,TCT,HPV16,18 detection and colposcopic examination were conducted,90 cases diagnosed as CIN Ⅰ by colposcopic biopsy were selected and treated by LEEP shortly,a self-control method was used to compare the pathological results of colposcopic biopsy and LEEP.Results:The pathological coincidence of colposcopic biopsy and LEEP was 81.11%(73/90),the pathological results of 49 cases degraded to chronic cervicitis after LEEP,accounting for 54.44%(49/90),and the pathological results of 24 cases remained as CIN I,accounting for 26.67%(24/90);16 cases were found with positive HPV 16,18 among 73 cases whose pathological results did not upgrade after LEEP,accounting for 21.92%(16/73);the pathological results of 17 cases upgraded after LEEP,accounting for 18.89%(17/90),including 10 cases with CIN Ⅱ and 7 cases with CIN Ⅲ(4 cases without birth demand demanded total hysterectomy because of advance age;2 cases were diagnosed as CIN Ⅱ by postoperative pathological examination;one case were diagnosed as CIN I,one case were diagnosed as squamous cell carcinoma of middle differentiation because of gland involved after LEEP),13 cases were found with positive HPV16 and 18(6 cases in CIN Ⅱ group and 7 cases in CIN Ⅲ group),accounting for 76.47%(13/17);there was significant difference in positive rate of HR-HPV and viral load between low-grade cervical lesions and high-grade cervical lesions(P0.01),and the difference increased with the aggravation of cervical lesions;there was a correlation between results of TCT and pathological results after LEEP,the grades of TCT results were relative high,and the grades of pathological results after LEEP tended to relative high;there was significant difference in detection results between the two methods(P=0.000),the grades of TCT results were relative low,and the grades of pathological results after LEEP were probably low.Conclusion:Colposcopic biopsy is not accurate to definitely diagnose CIN Ⅰ,the possibility of missed diagnosis of high-grade cervical lesions exists,for the cases with CIN Ⅰ diagnosed by colposcopic biopsy and HSIL diagnosed by cytological test or the cases with high viral load of HR-HPV,missed diagnosis of high-grade cervical lesions should be paid more attention to;LEEP is superior to biopsy in definite diagnosis of CIN,which is an effective method in diagnosis and treatment of CIN.