分段诊刮诊断子宫内膜癌临床价值分析

Clinical value of the fractional dilatation & curettage in the diagnosis of endometrial cancer

目的评价分段诊刮诊断子宫内膜癌的临床价值。方法回顾分析2000年1月至2002年11月在上海交通大学医学院附属仁济医院收治的52例子宫内膜癌患者,比较分析患者术前的分段诊刮和术后子宫病理,判断肿瘤细胞分级的符合率。结果以术后子宫病理为标准,所有患者均为子宫内膜腺癌,分段诊刮和术后子宫病理在G1子宫内膜癌符合率为20%,G2肿瘤符合率为61.5%,G3内膜癌符合率为77.8%。G2和G3肿瘤病理诊断符合率同G1肿瘤相比较,差异均有统计学意义(G2对G1,χ2=6.6,P=0.010;G3对G1,χ2=7.726,P=0.005)。14例患者分段诊刮病理提示为"子宫内膜非典型增生",而术后子宫病理均诊断为"子宫内膜腺癌"。分段诊刮诊断细胞分级的准确率仅有50%(26/52),根据术后病理报告,48%(24/50)左右的患者肿瘤分级升级。当内膜癌浸润≥1/2子宫肌层深度时,病理诊断符合率(75.0%)显著高于侵入内膜层者(22.2%),差异有统计学意义(χ2=4.735,P=0.030)。结论分段诊刮和术后子宫病理在G3和≥1/2子宫肌层浸润子宫内膜癌患者保持较高的符合率。与术后病理比较,分段诊刮诊断子宫内膜癌肿瘤细胞组织学级别被降低。临床上应重视分段诊刮的内膜癌病理报告。

Objective To estimate the clinical value of the fractional dilatation ＆ curettage （D＆C） in the diagnosis of endometrial cancer. Methods The retrospective analysis was perforrued on fifty -two women diagnosed as endometrial cancer who were treated in the Department of Obstetrics ＆ Gynecology, Renji Hospital, Shanghai Jiao Tong University from Jan. 2000 to Nov. 2002. The comparative analysis was performed on the concordance rate of the tumor cellular grades which were done by D＆C and hysterectomy specimens, and we also analyzed the relationship between the concordance rate of grade and the depth of tumor invasion into myometrium. Results The concordance rate was 20% （3/15） in grade 1, 61.5% （16/26） in grade 2, and 77.8% （7/9） in grade 3, and the concordance rates for grade 2 and grade 3 were significantly higher than grade 1 （grade 2 - grade 1, P =0.010; grade 3 - grade 1 ,P =0.005） ; 14/52 （26.9%） patients diagnosed as atypical endometlial hyperplasia by D＆C were certified to be endometrial cancer by hysterectomy specimen. The accuracy of tumor grade diagnosis by D＆C was 50% （26/52） ,and 48% （24/50） tumor grade was downgraded. Concordance rate in patients＇tumor invasion to outer half of myometrim was higher than tumor localized in endometrium（ P = 0. 030）. Conclusion D＆C has a high accuracy in diagnosis of endometrial cancer in tumor grade 3 and tumor invasion to outer half of myometrium. Overall, 48% of endometrial cancer patients＇tumor grade seems to be downgraded by D＆C evaluation. So we must pay attention to the reports of the pathological diagnosis by D＆C.