恶性子宫内膜息肉的临床和宫腔镜特点及危险因素分析

Clinical and Hysteroscopic Characteristics and Risk Factors of Malignant Endometrial Polyps

目的研究恶性子宫内膜息肉的临床及宫腔镜特点,并对相关危险因素进行分析。方法收集2019-01/2022-01月在作者医院连续接受宫腔镜切除子宫内膜息肉的266例患者资料。根据子宫内膜息肉的组织病理学分析,将患者分为良性息肉组(n=237)和癌前或恶性息肉组(n=29)。回顾性评估患者的临床特征、组织病理学和宫腔镜检查结果。结果与良性息肉组相比,癌前或恶性息肉组患者的年龄、息肉直径>1.0 cm例数、异常子宫出血例数、息肉数量、多血管和不规则表面数量均显著增加(P<0.05)。在二元Logistic回归分析中,与癌前和恶性息肉显著相关的独立变量包括绝经状态、异常子宫出血、息肉数量>2、多血管和表面不规则。息肉数量>2、多血管和表面不规则的曲线下面积(area under the curve,AUC)分别为0.660、0.871和0.739。结合这些特征来区分恶性息肉具有最大诊断价值,AUC为0.940(95%CI:0.918~0.991),灵敏度和特异度分别为95.60%和93.40%。结论宫腔镜检查发现息肉数量>2、多血管和表面不规则可能会增加癌前和恶性子宫内膜息肉的风险。应对具有这些特定表现的息肉进行靶向活检以排除恶性病变。

Objective To investigate the clinical and hysteroscopic characteristics of malignant endometrial polyps,and to analyze its related risk factors.Methods Data from 266 patients who consecuously underwent hysteroscopic removal of endometrial polyps in author′s hospital from January 2019 to January 2022 was collected.The patients were divided into two groups:benign polyp group(n=237)and precancerous or malignant polyp group(n=29)according to histopathological analysis of endometrial polyps.The clinical features,histopathology and hysteroscopy results of the patients were retrospectively evaluated.Results Compared with the benign polyp group,the precancerous or malignant polyp group had significantly higher age,the number of polyp′s diameter>1.0 cm,the number of abnormal uterine bleeding cases,the number of polyps,the number of blood vessels and irregular surfaces(P<0.05).In bivariate Logistic regression analysis,independent variables significantly associated with precancerous and malignant polyps included menopausal status,abnormal uterine bleeding,the number of polyps>2,multiple blood vessels and irregular surfaces.The areas under the curve(AUC)for the number of polyps>2,multiple blood vessels and irregular surfaces were 0.660,0.871 and 0.739 respectively.Combining these features to distinguish malignant polyps had the greatest diagnostic value,with AUC of 0.940(95%CI:0.918-0.991),sensitivity and specificity were 95.60%and 93.40%respectively.Conclusion The hysteroscopy results show that the number of polyps>2,multiple blood vessels and irregular surfaces may increase the risk of precancerous and malignant endometrial polyps.A target biopsy of the polyps with these specific appearances should be performed to exclude malignant lesions.