宫腔镜直视下活检联合分段诊刮术对子宫内膜癌的诊断价值

Diagnosis value of hysteroscopically directed biopsy combined with segmental curettage for endometrial cancer

目的探讨宫腔镜直视下活检联合分段诊刮术对子宫内膜癌(EC)的诊断价值。方法对76例EC患者的临床资料进行回顾性分析,其中接受宫腔镜直视下活检+分段诊刮术的42例患者为A组,仅接受分段诊刮术的34例患者为B组。比较两组术前诊断与术后病理诊断结果的符合率,两种术前诊断方式对EC宫颈受累的预测价值及腹腔冲洗液细胞学阳性率的差异。结果术后病理检查显示,两组病理类型、病理分期比较,差异均无统计学意义(P> 0. 05)。两组术前诊断与术后病理结果的符合率比较,差异无统计学意义(P> 0. 05)。宫腔镜直视下活检联合分段诊刮术对EC的诊断灵敏度和阳性预测值高于单纯分段诊刮术(P <0. 05);两种术前诊断方式的诊断准确度、特异度、阴性预测值比较,差异无统计学意义(P> 0. 05)。两组细胞学阳性率比较,差异无统计学意义(P> 0. 05)。结论宫腔镜直视下活检联合分段诊刮术对EC有较高的诊断准确度,相对于单纯分段诊刮术在对EC宫颈受累的诊断方面更具优势,并不增加腹腔冲洗液细胞学阳性率的风险,在EC诊断中有重要意义。

Objective To explore the diagnostic value of hysteroscopically directed biopsy combined with segmental curettage for endometrial cancer（EC）. Methods The clinical data of 76 patients with EC were retrospectively analyzed. Forty-two patients were enrolled as group A and received hysteroscopically directed biopsy combined with segmental curettage,and 34 patients were enrolled as group B and received segmental curettage alone. The rate of coincidence between preoperative diagnosis and postoperative pathological diagnosis was compared between the two groups. The predictive value for cervical involvement by EC and the positive rate of cytology in peritoneal lavage fluid were compared between the two preoperative diagnostic methods. Results There were no significant differences between the two groups in pathological type,pathological stage, and the rate of coincidence between preoperative diagnosis and postoperative pathological diagnosis（P〉0. 05）. For cervical involvement by EC,the diagnostic sensitivity and positive predictive value of hysteroscopically directed biopsy combined with segmental curettage were higher than those of segmental curettage alone（P〉0. 05）. There were no significant differences in the accuracy,specificity and negative predictive value between the two preoperative diagnostic methods（P〈0. 05）. There was no significant difference in the positive rate of cytology between the two groups（P〉0. 05）. Conclusion Hysteroscopically directed biopsy combined with segmental curettage has a high diagnostic accuracy for EC,and is superior to simple segmental curettage for the diagnosis of cervical involvement by EC,but does not increase the risk of the positive rate of cytology in peritoneal lavage fluid,and has important significance in the diagnosis of EC.