细胞蜡块切片对子宫内膜癌早期诊断价值探讨

Value of endometrial cell paraffin section in early diagnosis of endometrial cancer

目的 子宫内膜癌进行早期诊断,对于提高疾病预后具有重要意义。本研究探讨子宫内膜细胞蜡块切片在子宫内膜癌早期诊断中的价值,为子宫内膜癌的早期诊断提供依据。方法 收集2016-07-01-2018-04-01汝州市第一人民医院收治的160例因不规则阴道出血和子宫内膜增厚等原因就诊患者的临床资料。观察内膜细胞石蜡切片形态学特点、不同方法对于子宫内膜癌的检测结果、不同方法对于子宫良性病变的检测结果、细胞石蜡切片诊断子宫内膜癌及子宫内膜良性病变的符合率。结果 正常子宫内膜包括增殖期、分泌期、月经期以及萎缩状态,能够通过各个时期腺体上皮细胞形态和间质细胞特点进行判断。经组织病理切片确诊的子宫内膜癌合计48例,其中40例在子宫内膜细胞蜡块切片中也被检测到;另外8例,6例被诊断为非典型子宫内膜增生,2例被诊断为无非典型子宫内膜增生,两种诊断方法比较差异无统计学意义,χ~2=3.248,P=0.441。经组织病理切片确诊的子宫内膜良性病变合计58例,其中46例在子宫内膜细胞蜡块切片中也被检测到;没有被检出的12例,6例为子宫内膜息肉,6例为非典型性子宫内膜增生,两种诊断方法比较差异无统计学意义,χ~2=5.662,P=0.294。细胞石蜡切片诊断子宫内膜癌的敏感性为83.33%,特异性为98.21%,阳性预测值为95.23%,Kappa值为0.69,诊断准确率为93.75%;细胞石蜡切片诊断子宫内膜良性病变的敏感性为79.31%,特异性为96.08%,阳性预测值为92.00%,Kappa值为0.63,诊断准确率为90.00%。结论 子宫内膜细胞蜡块切片对子宫内膜癌早期诊断和组织病理法具有较高的一致性。

OBJECTIVE Early diagnosis of endometrial cancer is of great significance for improving the prognosis of the disease.The study aims to explore the value of endometrial cell paraffin section in the early diagnosis of endometrial cancer.METHODS The clinical data of 160patients were collected who were treated in our hospital from July 1,2016to April 1,2018.To observe the morphological characteristics of paraffin sections of endometrial cells,the results of different methods for the detection of endometrial cancer,the results of different methods for the detection of benign uterine lesions,and the coincidence rate of paraffin sections for the diagnosis of endometrial cancer and benign endometrial lesions.RESULTS Normal endometrium including proliferative phase,secretory phase,menstrual phase and atrophic state,which can be judged by glandular epithelial cell morphology and interstitial cell characteristics at various stages.A total of 48endometrial cancers were diagnosed by histopathological sections,of which 40were also detected in the endometrial cell paraffin section.Among 8patients,6patients were diagnosed as atypical uterus membrane hyperplasia,2cases were diagnosed as atypical endometrial hyperplasia.The difference between the two methods was not statistically significant,χ2=3.248,P=0.441.A total of 58endometrial benign lesions were diagnosed by histopathological section.Among them,46patients were also detected in the endometrial cell paraffin section.Six cases were not detected as endometrial polyps,and other 6cases were found.The difference between the two methods was not statistically significant,χ2=5.662,P=0.294.The sensitivity of paraffin sections for the diagnosis of endometrial cancer was 83.33%,the specificity was 98.21%,the positive predictive value was 95.23%,the Kappa value was 0.69,and the diagnostic accuracy was 93.75%.Cell paraffin The sensitivity of section diagnosis of endometrial benign lesions was 79.31%,the specificity was 96.08%,the positive predictive value was 92.00%,Kappa value was 0.63,and the diagnostic accuracy was 90.00%.CONCLUSION The endometrial cell paraffin section has a high consistency with histopathology in the early diagnosis of endometrial cancer.