子宫内膜细胞学联合血清TAP检测对子宫内膜癌初筛价值

Value of endometrial cytology combined with TAP in screening of endometrial cancer

目的子宫内膜细胞学检查(endometrial cytology,ECT)用于子宫内膜癌初筛,其准确性仍待提高。本研究评估ECT联合异常糖链糖蛋白(tumor abnormal protein,TAP)对子宫内膜癌初筛应用价值。方法选取2015-01-01-2018-10-31聊城市第二人民医院妇科收治的有子宫内膜癌高危因素的患者共350例,使用ECT和诊断性刮宫术病理检查,同时测定血清标志物CA125及TAP水平,与病理结果比较确定2种筛查方法及标志物对本病诊断价值。结果350例子宫内膜癌患者ECT和诊断性刮宫取材满意率分别为95.7%和96.8%,差异无统计学意义,χ^2=0.639,P=0.424;ECT采集时间为(4.68±1.23)min,短于诊断性刮宫的(13.35±2.35)min,t=24.382,P=0.016;ECT出血量为(1.58±0.39)mL,少于诊断性刮宫的(13.06±2.85)mL,t=30.576,P=0.039。取材满意的335例患者采用ECT发现子宫内膜癌42例,良性病变293例;诊断性刮宫术病理发现子宫内膜癌40例,良性病变295例。子宫内膜癌患者与内膜良性病变患者比较,TAP阳性灵敏度为62.5%,高于CA125的15.0%,差异有统计学意义,χ^2=19.013,P<0.001。ECT+TAP联合筛查子宫内膜癌灵敏度为95.0%,高于ECT的77.5%,χ^2=5.165,P=0.023;ECT+TAP联合筛查特异度为86.8%,低于ECT的96.3%,χ^2=17.132,P<0.001。ECT+TAP联合筛查准确度为49.4%,低于ECT的73.8%,χ^2=7.679,P=0.006。结论ECT联合TAP筛查安全可靠,可以作为子宫内膜癌高危人群筛查方法。

OBJECTIVE The accuracy of endometrial cytology(ECT)in the preliminary screening of endometrial carcinoma still needs to be improved.The purpose of this study was to explore the application value of ECT and tumor abnormal protein(TAP)in the early screening of endometrial cancer.METHODS Totally 350 patients with high risk of endometrial cancer were collected at the Department of Gynecology of Liaocheng Second People's Hospital From January 1,2015 to October 31,2018.All patients were treated with ECT and histological examination of diagnostic curettage and serum CA125 and TAP were detected.Pathological results were compared to determine the diagnostic value of two screening methods and markers.RESULTS There was no statistically significant difference in the satisfaction rate between ECT(95.7%)and diagnostic curettage(96.8%),Х^2=16.911,P=2.362.The collection time of ECT was shorter than that of diagnostic curettage(4.68±1.23 vs 13.35±2.35,t=24.382,P=0.016);the amount of ETC bleeding was less than that of diagnostic curettage(1.58±0.39 vs 13.06±2.85,t=30.576,P=0.039).Totally 42 cases of endometrial carcinoma and 293 cases of benign lesions were found by ECT in 335 patients with satisfactory sampling.Totally 40 cases of endometrial carcinoma and 295 cases of benign lesions were found by diagnostic curettage.Compared with patients with benign endometrial lesions,the sensitivity of TAP was higher than that of CA125(62.5%vs 15.0%=19.013,P<0.001).The sensitivity of ECT+TAP combined screening for endometrial cancer was higher than that of ECT(95.0%vs 77.5%,=5.165,P=0.023);the specificity of ECT+TAP combined screening was lower than that of ECT(86.8%vs 96.3%,X^2=17.132,P<0.001).The accuracy of combined screening of ECT+TAP was lower than that of ECT(49.4%vs 73.8%,Х^2=7.679,P=0.006).CONCLUSION ECT combined with TAP is a safe and reliable method in screening of high-risk groups of endometrial cancer.