宫腔镜结合ER、PR表达对早期诊断子宫内膜样腺癌的临床价值

The significance of hysteroscopy combined with the expression of ER and PR in early diagnosis of endometrial carcinoma

目的探讨宫腔镜结合子宫内膜组织雌激素受体(ER)、孕激素受体(PR)表达对早期诊断子宫内膜样腺癌的临床价值。方法选择2007年1月至2012年1月于我院妇科行宫腔镜检查及诊刮术的840例患者,应用免疫组化EnVision法检测各类子宫内膜组织中ER、PR的表达情况。结果在本组840例患者中,经宫腔镜检查诊断子宫内膜样腺癌25例,经组织病理诊断子宫内膜样腺癌26例。宫腔镜诊断的敏感度为96.2%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为99.9%。在本组的10例正常子宫内膜、20例子宫内膜不典型增生和26例子宫内膜样腺癌的子宫内膜组织中,ER、PR阳性表达率逐渐降低,有显著性差异(P<0.01)。随着病理分级及FIGO分期增加,ER、PR阳性表达降低,且降低趋势具有统计学意义(P<0.01),但在肌层浸润深度和有无淋巴结转移方面,ER、PR的表达组间无显著性差异(P>0.05)。结论宫腔镜检查结合子宫内膜组织ER、PR的表达检测对子宫内膜样腺癌早期诊断有重要的意义。

Objective To evaluate the significance of hysteroscopy combined with the expression of ER and PR in early diagnosis of endometrial carcinoma. Methods 840 patients were examined by hysteroscopy, of which the expression of ER and PR were detected with EnVision immunohistochemical method. Results In 840 patients, there were 25 cases of endo- metrial carcinoma. The sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy were 96. 2% , 100. 0% , 100. 0% and 99.9% , respectively. There was a significant difference among 26 cases of endometrial ad- enocarcinoma, 20 cases of uterus atypical hyperplasia endometrium and 10 cases of normal endometria （ P 〈 0. 01 ）. The ex- pression level of ER and PR decreased with the increasing clinical stages and pathologic grades of endometrial adenocarcinoma （P 〈 0. 01 ） , but were not significantly different in terms of lymphnode metastasis and depth of myometrial invasion of endom- etrial adenocarcinoma （P 〉 0.05 ）. Conclusion Hysteroscopy can be used to observe the endometrial tissue and biopsies, and is of great significance in early diagnosis of endometrial carcinoma when combined with the expression of ER and PR.