从细胞病理角度分析子宫内膜细胞学检查筛查子宫内膜癌的可行性

Feasibility of endometrial cytology screening for endometrial cancer:from cytopathologic point of view

目的评价子宫内膜细胞学检查(endometrial cytology test,ECT)诊断子宫内膜癌及其癌前病变的准确性,从细胞学角度分析其作为子宫内膜癌筛查手段的可行性。方法收集2015年1月~2018年9月安徽医科大学第二附属医院同时行ECT及子宫内膜组织学检查的患者1725例,液基细胞学涂片及石蜡切片分别行细胞学诊断和组织病理学诊断;将细胞学诊断结果与组织病理学诊断结果进行比较,分析ECT诊断的准确性、敏感性、特异性、阳性预测值、阴性预测值。结果1725例患者中,ECT诊断肿瘤细胞阴性1511例,非典型子宫内膜细胞,意义不明确(atypical endometrial cells,undetermined significance,ATEC-US)85例,非典型子宫内膜细胞,不排除内膜不典型增生或更严重情况(atypical endometrial cells,cannot exclude atypical endometrial hyperplasia or more,ATEC-A)92例,可疑恶性细胞26例,恶性细胞11例;ECT与组织病理学诊断的总符合率、敏感性、特异性、阳性预测值、阴性预测值分别是94.6%、93.0%、94.7%、31.0%、99.8%。结论从细胞学诊断思维深化对宫腔内取样的子宫内膜样本的全面认识,是提高诊断准确性的关键。ECT可作为筛查子宫内膜癌及其癌前病变的有效方法。

Purpose To evaluate the accuracy of endometrial cytology test(ECT)in the diagnosis of endometrial carcinoma and its precancerous lesions,and to analysis the feasibility of endometrial cytology test screening for endometrial cancer from cytopathologic point of view.Methods A total of 1725 cases of ECT and endometrial histology were collected from January 2015 to September 2018 in the Second Affiliated Hospital of Anhui Medical University.The liquid-based cell smears and formalin-fixed-paraffin-embedded(FFPE)tissue sections were used for cytological and histological diagnosis,respectively.A comparison was made of the results of cytology and histology to assess the accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of the ECT diagnoses.Results In 1725 cases,the cytopathologic diagnosis negative for malignancy was 1511 cases.Atypical endometrial cells,undetermined significance(ATEC-US)were 85 cases.Atypical endometrial cells,cannot exclude atypical endometrial hyperplasia or more(ATEC-A)were 92 cases.Suspected malignant cells were 26 cases.Malignant cells were 11 cases.The total coincidence rate of ECT and histological diagnosis,the diagnostic sensitivity,specificity,positive predictive value and negative predictive value were 94.6%,93.0%,94.7%,31.0%and 99.8%,respectively.Conclusion Deepening the overall understanding of endometrial cells in intrauterine sampling from cytopathologic point of view is the key to improve the accuracy of diagnosis.ECT cytological diagnosis can be used as an effective method for the screening of endometrial cancer and its precancerous lesion.