子宫内膜增殖症诊断性刮宫价值的评价

Evaluation of diagnosis of endometrial hyperplasia by curettage

目的 评价应用诊断性刮宫 (简称诊刮 )方法诊断子宫内膜增生症 (EH)的准确性。方法 对门诊诊刮为EH ,短期内行子宫切除术的 15 0例患者作病理诊断 ,并与诊刮诊断进行比较分析 ,还采用SP免疫组织化学法对 38例诊刮诊断为复合型不典型增生 (CAH)患者行增殖细胞核抗原(PCNA)染色。结果 15 0例患者诊刮诊断为单纯型增生 (SH)、复合型增生 (CH)、单纯型不典型增生(SAH)和CAH分别为 5 3、11、2 6和 6 0例 ;经子宫切除后病理学诊断为SH、CH、SAH及CAH者分别为6 5、7、15、2 9例 ,其余 34例为子宫内膜癌 (EC)。诊刮对SH诊断的准确性较高 ,而对CAH诊断的准确性则较差 ;SAH、CAH并存EC显著高于SH、CH(χ2 =2 6 .3,P <0 .0 0 1)。CAH并存EC者显著高于SAH(χ2 =9.78,P <0 .0 0 5 )。绝经后不典型增生患者并存EC的可能性显著高于绝经前患者 (χ2 =3.93,P<0 .0 5 )。并存EC的CAH患者PCNA阳性表达率明显高于未并存EC者 (P =0 .0 2 ) ;且其表达强度也明显强于未并存EC患者 (Uc=3.6 6 ,P <0 0 5 )。结论 诊刮诊断SH的准确性较高 ,而诊断CAH的准确性较低 ;CAH并存EC的比例比较高 ;

Objective To evaluate the accuracy of diagnosing endometrial hyperplasia (EH) by curettage. Methods 150 cases who had been diagnosed as EH by curettage and received hysterectomy shortly after were studied retrospectively. All of the specimens obtained from curettage and operation underwent pathological examination. The results of pathological diagnosis of these two kinds of specimens were compared. Proliferating cell nuclear antigen (PCNA) expression was examined by immunohistochemistry in 38 cases diagnosed as complex atypical hyperplasia (CAH). Results Fifty three cases were diagnosed as simple hyperplasia (SH), eleven cases as complex hyperplasia (CH), twenty six cases as simple atypical hyperplasia (SAH), and sixty cases as CAH by curettage. Rediagnosis was made for all patients after hysterectomy. Pathological examination of the specimens from operation diagnosed 65 cases as SH, 7 cases as CH, 15 cases as SAH, 29 cases as CAH, and 34 cases as EC. The general accuracy of histological diagnosis by curettage was 76.7%～92.6%. Coexistence with EC was more common in cases with SAH and CAH than in cases with SH and CH (χ 2=26.3, P <0.01). Coexistence with EC was more common in cases with CAH than in cases with SAH (χ 2=9.78, P <0.005). Among the CAH cases, coexistence with EC was more common in postmenopausal patients than in premenopausal patients (χ 2=3.93, P <0.05). Among the CAH cases, the positive rate of PCNA expression was higher and strength of positivity greater in those cases with EC ( Uc =3.66, P <0.05). Conclusion The accuracy of curettage is rather high in diagnosing SH and relatively low in diagnosing CAH. CAH often coexists with EC. Examination of PCNA expression may help differentiate between CAH and EC.