中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
4期
1423-1426
,共4页
子宫内膜肿瘤%肿瘤,组织学类型%肿瘤分级%宫颈浸润
子宮內膜腫瘤%腫瘤,組織學類型%腫瘤分級%宮頸浸潤
자궁내막종류%종류,조직학류형%종류분급%궁경침윤
Endometrial neoplasms%Neoplasms by histologic type%Grade%Cervical involvement
目的了解子宫内膜癌术前诊刮病理的诊断价值。方法回顾性分析2006年3月至2011年4月在我院初治的282例子宫内膜癌患者的临床病理资料，以术后病理为金标准，评价术前诊刮病理诊断肿瘤组织学分型、分级及宫颈浸润的准确性。结果术前诊刮病理诊断肿瘤组织学类型的符合率为88.3％，其中Ⅰ型子宫内膜癌的符合率为94.8％，Ⅱ型子宫内膜癌的符合率为55.6％。其诊断肿瘤组织学分级（ grade， G）的符合率仅为66.0％，尤其诊断为G1的符合率（52.6％）显著低于诊断为G2（71.2％）和G3（82.5％）的符合率，差异有统计学意义（G1 vs．G2，P＝0.018，G1 vs．G3，P＝0.0015）；有47.4％的G1患者术后病理升为G2或G3，且术前诊断为临床Ⅰ期的子宫内膜癌患者随组织学分级的增加（ G1→G2→G3）其术后的手术病理分期（≥Ⅱ期）升高的风险从12.5％增加到25.8％和28.1％，差异具有统计学意义（χ2＝4.3412， P ＝0.0372）。分段诊刮病理诊断宫颈受累的准确度为65.9％，其假阳性率高达40.7％。结论子宫内膜癌术前诊刮病理诊断肿瘤组织学类型的符合率较高，尤其是诊断Ⅰ型子宫内膜癌的符合率高达94.8％，而诊断Ⅱ型子宫内膜癌、肿瘤组织学分级和宫颈受侵的符合率偏低，特别是诊刮病理为低级别（ G1）的子宫内膜癌，有近半数患者术后病理升级为G2或G3。
目的瞭解子宮內膜癌術前診颳病理的診斷價值。方法迴顧性分析2006年3月至2011年4月在我院初治的282例子宮內膜癌患者的臨床病理資料，以術後病理為金標準，評價術前診颳病理診斷腫瘤組織學分型、分級及宮頸浸潤的準確性。結果術前診颳病理診斷腫瘤組織學類型的符閤率為88.3％，其中Ⅰ型子宮內膜癌的符閤率為94.8％，Ⅱ型子宮內膜癌的符閤率為55.6％。其診斷腫瘤組織學分級（ grade， G）的符閤率僅為66.0％，尤其診斷為G1的符閤率（52.6％）顯著低于診斷為G2（71.2％）和G3（82.5％）的符閤率，差異有統計學意義（G1 vs．G2，P＝0.018，G1 vs．G3，P＝0.0015）；有47.4％的G1患者術後病理升為G2或G3，且術前診斷為臨床Ⅰ期的子宮內膜癌患者隨組織學分級的增加（ G1→G2→G3）其術後的手術病理分期（≥Ⅱ期）升高的風險從12.5％增加到25.8％和28.1％，差異具有統計學意義（χ2＝4.3412， P ＝0.0372）。分段診颳病理診斷宮頸受纍的準確度為65.9％，其假暘性率高達40.7％。結論子宮內膜癌術前診颳病理診斷腫瘤組織學類型的符閤率較高，尤其是診斷Ⅰ型子宮內膜癌的符閤率高達94.8％，而診斷Ⅱ型子宮內膜癌、腫瘤組織學分級和宮頸受侵的符閤率偏低，特彆是診颳病理為低級彆（ G1）的子宮內膜癌，有近半數患者術後病理升級為G2或G3。
목적료해자궁내막암술전진괄병리적진단개치。방법회고성분석2006년3월지2011년4월재아원초치적282례자궁내막암환자적림상병리자료，이술후병리위금표준，평개술전진괄병리진단종류조직학분형、분급급궁경침윤적준학성。결과술전진괄병리진단종류조직학류형적부합솔위88.3％，기중Ⅰ형자궁내막암적부합솔위94.8％，Ⅱ형자궁내막암적부합솔위55.6％。기진단종류조직학분급（ grade， G）적부합솔부위66.0％，우기진단위G1적부합솔（52.6％）현저저우진단위G2（71.2％）화G3（82.5％）적부합솔，차이유통계학의의（G1 vs．G2，P＝0.018，G1 vs．G3，P＝0.0015）；유47.4％적G1환자술후병리승위G2혹G3，차술전진단위림상Ⅰ기적자궁내막암환자수조직학분급적증가（ G1→G2→G3）기술후적수술병리분기（≥Ⅱ기）승고적풍험종12.5％증가도25.8％화28.1％，차이구유통계학의의（χ2＝4.3412， P ＝0.0372）。분단진괄병리진단궁경수루적준학도위65.9％，기가양성솔고체40.7％。결론자궁내막암술전진괄병리진단종류조직학류형적부합솔교고，우기시진단Ⅰ형자궁내막암적부합솔고체94.8％，이진단Ⅱ형자궁내막암、종류조직학분급화궁경수침적부합솔편저，특별시진괄병리위저급별（ G1）적자궁내막암，유근반수환자술후병리승급위G2혹G3。
Objective To explore the value of curettage pathology in the diagnosis of endometrial cancer . Methods The retrospective analysis was performed on 282 patients diagnosed as endometrial cancer who were treated initially in Cancer Hospital Chinese Academy of Medical Science from March 2006 to April 2011 .The pathology of hysterectomy specimens is considered as golden standard , the authors evaluated the accuracy of preoperative endometrial curettage pathology in diagnosing tumor histologic types ,grades and cervical involvement of endometrial cancer .Results The overall accuracy of tumor types was 88.3% in preoperative curettage pathology (94.8%for typeⅠand 55.6% for typeⅡ,respectively).The overall accuracy of grades in preoperative curettage pathology was only 66.0%.The accuracy for G1(52.6%)was significantly lower than for G2(71.2%)and G3 (82.5%),and the difference had statistical significance (G1 vs.G2,P=0.018;G1 vs.G3,P=0.0015).47.4% in G1 of preoperative pathology upgraded to G 2 or G3 in the postoperative pathology .Furthermore ,accompanied by the rising of grade(G1→G2→G3),the risk of clinical stage I raised to pathological stageⅡand above was from 12.5%to 25.8%and to 28.1%,and the difference had statistical significance (χ2 =4.3412 ,P=0.0372 ) .The accuracy of dilatation and curettage pathology in diagnosis of cervical infiltration in endometrial cancer was 65.9%,and the false-positive rate was up to 40.7%.Conclusions The accuracy rate of curettage pathology in diagnosis of tumor types is high,especially in diagnosis of typeⅠ(up to 94.8%).However,it is low in diagnosis of typeⅡ,tumor grades and cervical infiltration.Especially for grade 1,about half of which upgraded to 2 and 3 in the final pathology.
