子宫内膜细胞采集器筛查子宫内膜癌应用价值分析

Value of Endometrial Sampling Device in Screening Endometrial Cancer and Precancerous Lesions

目的探讨子宫内膜细胞采集器在筛查子宫内膜癌及癌前病变中的应用价值。方法 2014年4月~2015年10月就诊需排除子宫内膜病变的患者208例,行经阴道超声检查(TVS)、血清CA125联合HE4检测、子宫内膜细胞采集器活检子宫内膜、宫腔镜下诊刮术,以宫腔镜下诊刮的病理诊断结果作为"金标准",计算子宫内膜细胞采集器的取材满意率,比较子宫内膜细胞采集器、宫腔镜诊刮、TVS、血清CA125联合HE4诊断子宫内膜癌及癌前病变的敏感度、特异性及符合率。结果 (1)子宫内膜细胞采集器活检内膜取材满意率86.5%(180/208),宫腔镜诊刮取材满意率92.3%(192/208),两者差异无统计学意义(P>0.05)。(2)子宫内膜细胞采集器活检子宫内膜筛查子宫内膜癌及癌前病变的敏感度、特异性及符合率分别为63.6%、100%、96.2%,均高于TVS及CA125联合HE4检测,差异有统计学意义(P<0.05)。结论子宫内膜细胞采集器可获取较满意的子宫内膜组织标本进行病理诊断,诊断子宫内膜癌及癌前病变的敏感度、特异性及符合率均较高,可作为子宫内膜癌的筛查手段。

Objective To study the feasibility, accuracy and value of endometrial sampling device as a screening tool for endometrial cancer and precancerous lesions. Methods From April 2014 to October 2015, 208 cases in our hospital that need to rule out endome- trial lesions, respectively underwent transvaginal sonography（ TVS）, serum tumor markers carbohydrate antigen 125 （CA125） joint human epididymis protein 4 （HE4） detection, endometrial sampling device and endometrial curettage hysteroscopy. Among TVS, serum tumor marker CA125 and HE4 detection, endometrial biopsy acquisition, the sensitivity, specificity and agreement rate of diagnose endometrial cancer and precancerous lesions were compared in cases whose tissues were sampled qualified by the above methods. Results （ 1 ） The satisfaction rate of endometrial biopsy acquisition was 86.5% （180/208） , the satisfaction rate of endometrial curettage hysteroscopy was 92.3% （192/208）, and there was no significant difference between them （P 〉 0.05 ）. （2）The sensitivity, specificity and agreement rate of diagnose endometrial cancer and precancerous lesions by using endometrial sampling device were 63.6% , 100% ,96.2% , which was the highest among TVS, CA125 and HE4 （P 〈 0.05）. Conclusion Endometrial sampling device can get qualified endometrial tissue specimens for diagnosis of endometrial cancer and precancerous lesions. It has high sensitivity, specificity and agreement rate, which can be used to screening endometrial cancer.