子宫内膜采集器获取标本的满意度及相关因素对病理诊断符合率的影响

Influence of sampling satisfaction using endometrial sampling device and related factors for pathology diagnostic accordance rate

目的观察子宫内膜采集器获取子宫内膜组织标本的满意度及相关因素对于病理诊断符合率的影响，探讨子宫内膜采集器作为子宫内膜癌及癌前病变筛查手段时需注意的问题。方法收集2012年3月至2014年3月期间因子宫内膜增厚、不规则阴道流血等原因在北京大学人民医院进行诊治的患者204例，采用子宫内膜采集器获取微量子宫内膜组织进行病理诊断，并将其结果与随后采用常规方式（包括诊刮、宫腔镜检查或子宫切除术）获得的病理诊断结果相比较，分析标本获取量、病变病理类型、标本取材熟练程度与病理诊断符合率间的相互关系。结果子宫内膜采集器获取的标本与常规方式的标本相比较，不典型增生及子宫内膜癌的标本满意率最高，为90％（27／30），其病理诊断符合率为67％（20／30）；大致正常子宫内膜组织的病理诊断符合率最高，为82．9％（126／152），其标本满意率为74．3％（113／152）。92．2％（188／204）的患者可以通过子宫内膜采集器获取到子宫内膜腺体成分，其中77．0％（157／204）观察到≥5个腺体、62．3％（127／204）观察到≥10个腺体；观察到≥5个但〈10个腺体时，病理诊断符合率为76．7％（23／30），≥10个腺体时，病理诊断符合率为92．9％（118／127）。研究开展第1阶段（2012年3月至2013年3月）获取标本的满意度低于第2阶段（2013年4月至2014年3月）。结论对于子宫内膜采集器获取标本的病理诊断应关注标本满意度，子宫内膜组织标本至少应获取5个及以上的腺体成分，才能基本满足组织病理学诊断的要求。标本取材熟练程度及病变的病理类型会影响标本满意度，进而影响病理诊断符合率。

Objective To observe the satisfaction of obtaining endometrial tissue in using endometrial sampling device and explore the influence for pathology diagnostic accordance rate, and to discuss the problem needs to focus in obtaining endometrial tissue with endometrial sampling device for endometrial cancer and precancerous lesion screening. Methods Totally 204 cases using endometrial sampling device with the subsequent diagnostic curettage, hysteroscopy, or hysterectomy were collected. A comparison of pathological diagnosis between two methods was made. The relationship among specimen quantity, proficiency, pathological types and diagnostic accordance rate were analyzed. Results The diagnostic accordance rate of endometrial cancer and precancerous lesion of two methods was 67% （20/30）. 92.2% （188/204） cases successfully got the endometrial glands, 77.0% （157/204） cases got≥5 specimens of glands and 62.3% （127/204） cases got ≥10 specimens of glands. When obtaining≥5 but〈 10 endometrial glands, the diagnostic accordance rate was 76.7% （23/30）; however, obtaining ≥10 endometrial glands, the diagnostic accordance rate was 92.9% （118/127）. The degree of specimen satisfaction of the first phase was lower than the second phase. Conclusions Obtaining ≥5 endometrial glands in using endometrial sampling device could satisfy the requirement of the basic pathological diagnosis. The proficiency of sampling and the pathological types could influence the degree of specimen satisfaction, and then influence the diagnostic accordance rate.