分段诊刮对子宫内膜癌术前诊断的临床价值评价

Evaluation of fractional D&C in preoperational diagnosis of endometrial cancer

目的:探讨分段诊断性刮宫对子宫内膜癌病理分级及术前临床分期的价值。方法:回顾性分析102例子宫内膜癌患者手术前分段诊断性刮宫和手术病理结果,并分析其可能的临床病理影响因素。结果:分段诊刮和术后病理组织学结果组织类型完全符合78例,符合率为76.5%。其中子宫内膜样腺癌符合率为85.4%,非子宫内膜样腺癌符合率为50%,两者差异有统计学意义,P<0.05。组织学分级一致,符合率为66.3%。在其余患者中,术后病理学分级升高者24例,降低者9例。组织学分级本身是影响诊刮与术后病理分级一致性的因素,P<0.05。患者的年龄、是否绝经、有无高血压、糖尿病史、肌层侵犯及宫颈受累情况,在术后病理分级升高患者与其他患者间差异均无统计学意义,P>0.05。分段诊刮判断宫颈受累的敏感性71.4%,特异性94.7%,阳性预测值50%,阴性预测值97.8%。结论:在FIGO新分期标准下,分段诊刮仍然是子宫内膜癌术前病理分级及分期的有效方法;宫颈搔刮的阴性结果对判断宫颈受累情况更有意义;部分患者存在术后病理分级升高的情况。

OBJECTIVE：To evaluate the clinical significance of fractional dilatation and curettage（D＆C） in preoperational diagnosis of endometrial carcinoma of tumor grades and clinical stage under new FIGO staging system. METHODS： Totally 102 patients of endometrial carcinoma were retrospectively analyzed. Tumor pathological types,grades and tumor stages were compared between D＆C and hysterectomy specimens, and the relevant clinical and pathological factors were analyzed. RESULTS： The concordance rates for pathological types was 76.5% with endometriod carcinoma 85.4% vs the non--endometriod carcinoma 500%（P〈0.05）. The concordance rate for pathological grades was 66.3%. And 24 patients were downgraded while 9 patients were upgraded after comparison of postoperative specimens. Tumor with high grade （G2/G3 ） had higher concordance rate （P（0.05）. No association between high concordance rate and the age,post meno- pause, history of hypertension and diabetes, invasion of myometrium, cervical involvement were found （P〈 0.05）. For diagnosis of cervical involvement sensitivity and specificity of fractional D＆C were 71.4% and 94.7% accordingly,and the positive predictive value of fractional D＆C was 50%, negative predictive value was 97.8%. CONCLUSIONS： Fractional dilatation and curettage is still an acceptable diagnostic tool for preoperational evaluation endometrial cancer patients under new FIGO staging system. D＆C have a high accuracy in the diagnosis of endometrial cancer in grade 2 and 3 tumors and tumor without involvement of cervix. A certain number of endometrial cancer patients＇ tumor grades seemed to be decreased by D＆C evaluation.