子宫内膜细胞学检查在子宫内膜癌筛查中的应用  

Accuracy of the endometrial cytology test for the screening of endometrial cancer

作　　者：杨曦[1] 廖秦平[1] 吴成[1] 张乃怿 赵健[2] 陈锐[2] 张楠 马秀华[5] 高雨农 高万里[5] 郑虹 曾桢[1] 文佳[2] 董颖[3] 

机构地区：[1]北京大学第一医院妇产科,100034 [2]北京大学第一医院细胞学中心,100034 [3]北京大学第一医院病理科,100034 [4]北京大学肿瘤医院妇科 [5]北京市大兴区人民医院妇产科

出　　处：《中华妇产科杂志》2013年第12期884-890,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市科学技术委员会首都临床特色应用研究（D101100050010047）;首都医学发展科研基金（2009-1010）

摘　　要：目的评价子宫内膜细胞学检查（ECT）筛查子宫内膜癌及其癌前病变的准确性，探讨其作为子宫内膜癌筛查手段的临床应用价值。研究子宫内膜癌及其癌前病变的流行病学特征及发病的高危因素，为明确子宫内膜癌筛查的适宜人群提供依据。方法选取2009年3月至2013年5月在北京大学第一医院（1377例）、北京市大兴区人民医院（210例）、北京大学肿瘤医院（130例）存在明确手术指征行宫腔镜检查且接受ECT检查的患者，共1717例，ECT采用液基薄层细胞学技术制片。以分段诊刮的组织病理学诊断为“金标准”，分析子宫内膜细胞学筛查子宫内膜癌的符合度、敏感度、特异度、阳性预测值和阴性预测值。同期选取存在明确手术指征行官腔镜检查且完整填写高危因素调查表的患者1716例，采用二分类logistic回归分析方法行子宫内膜癌及其癌前病变的高危因素分析。结果子宫内膜细胞学标本满意率为96．45％（1656／1717），组织病理学标本满意率为91．44％（1570／1717），两者比较，差异有统计学意义（P〈0．05）。子宫内膜细胞学筛查子宫内膜癌的符合度为88．2％，敏感度为87．3％，特异度为88．3％，阳性预测值为41．9％，阴性预测值为98．6％。组织病理学结果为子宫内膜癌及不典型增生的相关危险因素有：体质指数（BMI）≥25kg／m^2、年龄≥40岁、糖尿病、高血压、绝经和恶性肿瘤家族史（P均〈0．10），其中独立危险因素为BMI≥25kg/m^2、年龄／〉40岁、绝经和恶性肿瘤家族史（P均〈0．05）。结论子宫内膜细胞采集器结合液基薄层细胞学制片技术进行ECT用于子宫内膜癌及其癌前病变的筛查，准确性较高，用于筛查子宫内膜病变是可行的，具有临床应用价值。子宫内膜癌及其癌前病变的独立危险因素为年龄≥40岁、BMI≥25kg／m^2、绝经及恶性肿瘤家族史�Objective To evaluate the accuracy of endometrial cytology test （ECT） for the diagnosis of endometrial cancer or precancerous lesions and then discuss the value of ECT as a screening tool for endometrial cancer. Secondly, to investigate related characteristics and independent risk factors of epidemiology of endometrial carcinomas and atypical endometrial hyperplasia to advise proper crowd for endometrial carcinomas screening and monitoring. Methods Totally 1717 preoperative questionnaires on hysteroscopy ＋ dilation ＆ curettage, histopathology and endometrial cytological tests in Peking University First Hospital, People＇s Hospital of Beijing Daxing District and Beijing Cancer Hospital, from March 2009 to May 2013 were completed. Histopathologic diagnoses were used as the gold standard for determining the accuracy of ECT. Extrapolation：applied binary logistic regression method to narrow down the risk factors of histopathology and endometrial cytological examination. Results Satisfaction rate of cytological specimens and pathological specimens were 96. 45% （1656/1717） and 91.44% （ 1570/1717）, respectively. ECT provided sufficient material for the diagnosis significantly more often than histopathology （ P 〈 0. 05 ）. For the ECT diagnosis of endometrial cancer：accuracy was estimated at 88.2%, sensitivity at 87.3 %, specificity at 88.3%, positive predictive value （PPV）at 41.9%, negative predictive value （NPV）at 98.6%. Univariate analysis revealed that risk factors of diagnosis of endometrial carcinomas and atypical hyperplasia of histopathology were included ： body mass index （BMI）≥25kg/m^2, age ≥ 40 years old, diabetes mellitus, hypertension, menopause, family histm7 of malignant tumor （all P 〈0. 10）. Muhifactor analysis revealed that the independent risk factors were included： BMI ≥25kg/m^2, age≥ 40 years, menopause and family history of malignant tumor （ all P 〈 0. 05 ）. Conclusions The results of the current study indicated that the accuracy of ECT for

关 键 词：子宫内膜 细胞诊断学 子宫内膜肿瘤 癌前状态 普查 

分 类 号：R737.33[医药卫生—肿瘤]