子宫内膜癌患者术前诊刮与术后大体病理对比研究

Comparison of Results between Dilatation and Curettage Pathology and Pos-tsurgical Gross Pathology in the Patients of Endometrial Cancer

目的:评价诊断性刮宫(诊刮)的病理结果对于子宫内膜癌患者术前评估的价值。方法:选择北京协和医院术前诊刮及术后大体病理均为子宫内膜癌的患者共217例,与术后大体病理进行对比,从病理类型及组织学分级分别讨论其诊断准确率。结果:术前诊刮病理类型显示子宫内膜样癌196例,非子宫内膜样癌21例;与术后大体病理类型比较敏感度97.4%,特异度72.7%,Kappa值=0.716。术前病理组织学分级高分化G1 135例,中分化G2 50例,低分化G3 32例,与术后病理组织学分级比较加权Kappa值=0.596,Z=11.72,P=0.000。与术后大体病理相比较,术前G3组误诊率明显高于术前G1组,术前G2组与其他两组之间误诊率无明显差异。结论:术前诊刮病理对于子宫内膜癌患者术前评估有重要意义,两种病理比较,病理类型的一致性较高,术前组织学分级为低分化的患者误差较大。

Objective：To compare the diagnostic accuracy between dilatation and curettage（DC） pathology and postsurgical gross pathology results in the patients of endometrial carcinoma. Methods：217 clinical data of patients who were diagnosed as endometrial carcinoma both by DC and post-surgical gross pathology were collected, compared by the type of organization and histological grade to evaluate the accuracy of DC pathology. Results：There were 196 endometrioid and 21non-endometrioid carcinoma of the DC pathology respectively, the sensitivity 97.4% and specificity 72.7%, Kappa value was 0.716 compared with the post-surgical gross pathology. The numbers of patients with grade 1, grade 2 and grade 3 were 135, 50 and 32 by DC pathology. Compared with the post-surgical gross pathology, the weighted Kappa value was 0.596（Z=11.72,P=0.000）. The misdiagnosis rate by DC was significantly higher in grade 3 versus grade 1 and it was not significant in grade 2 versus the other two groups. Conclusions：Pre-surgical DC pathology is very helpful and important in the pre-surgical evaluation of endometrial carcinoma, type of organization reveals higher consistency and grade 3 has much higher misdiagnosis rate compared with the grade 1 groups by DC.