子宫腺肌病对子宫内膜样腺癌的影像学敏感性及病理特征的影响

Effect of adenomyosis on imaging sensitivity and pathological features of endometrioid adenocarcinoma

目的探讨子宫腺肌病(AM)对子宫内膜样腺癌(EEC)的术前诊断和病理特征的影响。方法收集2019年3月至2022年3月就诊于武汉大学人民医院并经武汉大学人民医院全面手术-病理分期证实为EEC的153例患者的临床病理资料进行回顾性分析,合并AM的患者纳入A组,未合并AM的EEC患者纳入B组。探讨AM对子宫内膜癌的诊断、病理进展及预后的影响。结果153例EEC患者中有46例合并AM,发生率为29.87%。B组患者处于绝经状态的比例显著高于A组(76.6%vs.54.3%,P=0.006);A组患者超声诊断符合率(15.2%vs.36.4%,P=0.009)、盆腹腔磁共振成像(MRI)诊断符合率(26.1%vs.50.5%,P=0.005)、诊刮病理符合率(56.5%vs.83.2%,P=0.000)均明显低于B组;与B组相比,A组患者肿瘤高中分化比例较高(93.5%vs.79.4%,P=0.000)、手术-病理分期处于早期的比例也较高(87.0%vs.60.7%,P=0.001)、肿瘤的深肌层浸润率较低(15.2%vs.32.7%,P=0.026)。结论合并AM的EEC患者会有更早的病理分期、更少的深肌层浸润发生、更好的肿瘤分化,预后更好。

Objective To investigate the influence of adenomyosis on preoperative diagnosis and pathological features of endometrioid adenocarcinoma.Methods The clinicopathological data of 153 patients in Renmin Hospital of Wuhan University from March 2019 to March 2022 were collected,to investigate the effect of AM on the diagnosis,pathological progress and prognosis of endometrial carcinoma.Patients with adenomyosis were assigned to group A,and endometrioid carcinoma without adenomyosis was assigned to group B.Results Among 153 patients with EEC,46 were complicated with AM,with an incidence of 29.87%.The proportion of menopausal patients in group B was significantly higher than that in group A(76.6%vs.54.3%,P=0.006).The coincidence rate of ultrasound diagnosis in group A(15.2%vs.36.4%,P=0.009),the coincidence rate of pelvic and abdominal magnetic resonance imaging(MRI)diagnosis(26.1%vs.50.5%,P=0.005)and pathological coincidence rate(56.5%vs.83.2%,P=0.000)were significantly lower than group B.Compared with group B,patients in group A had a higher proportion of high-grade tumor differentiation(93.5%vs.79.4%,P=0.000),a higher proportion of early surgical pathological staging(87.0%vs.60.7%,P=0.001),and a lower rate of deep muscular invasion(15.2%vs.32.7%,P=0.026).Conclusions Endometrioid carcinoma patients with adenomyosis have earlier pathological stages,less deep muscular invasion,better tumor differentiation and better prognosis.