诊断性刮宫、宫腔镜诊断性刮宫联合MRI对子宫内膜癌病理学及宫颈侵犯结果判读的影响分析  

Analysis on influence of diagnostic curettage and hysteroscopic diagnostic curettage combined with MRI on interpretation of pathology and cervical invasion results of endometrial cancer

作　　者：刘祖翠[1] 张俊[1] 蒋可 LIU Zucui;ZHANG Jun;JIANG Ke(Department of Gynecology,Affiliated Banan Hospital,Chongqing Medical University,Chongqing 401320,China;Department of Gynecology,Anyue County People’s Hospital,Ziyang,Sichuan 642350,China)

机构地区：[1]重庆医科大学附属巴南医院妇科,重庆401320 [2]安岳县人民医院妇科,四川资阳642350

出　　处：《重庆医学》2024年第20期3125-3131,共7页Chongqing Medical Journal

摘　　要：目的评价诊断性刮宫、宫腔镜诊断性刮宫联合MRI对子宫内膜癌病理学及宫颈侵犯结果判读的影响。方法纳入2012年1月至2023年12月在重庆医科大学附属巴南医院及安岳县人民医院治疗的1135例子宫内膜癌患者的相关病历资料,将术前影像学、组织学与术后组织学进行分型、分级统计比较。结果采用诊断性刮宫或宫腔镜诊断性刮宫进行取样,两种方法在术前病理分级及组织学分型的判读上均存在一定比例的低估或高估,两种取样方法获得的术前组织在病理分级和组织学分型的符合率比较,差异无统计学意义(P>0.05)。宫腔镜诊断性刮宫判断宫颈侵犯的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)、阳性似然比(+LR)、阴性似然比(-LR)和准确性分别为56.96%、85.34%、34.62%、93.57%、3.89、0.46、81.94%;宫腔镜诊断性刮宫联合MRI分别为73.08%、82.86%、36.54%、95.80%、4.26、0.32、81.69%。结论宫腔镜诊断性刮宫不能提高子宫内膜癌的组织学分型及病理分级的准确性。宫腔镜诊断性刮宫联合MRI检查,能更精确地评估子宫内膜癌宫颈侵犯情况,指导手术对宫颈、周边组织及淋巴结切除方式及范围的选择。Objective To evaluate the influence of diagnostic curettage,hysteroscopic diagnostic curettage combined with MRI on the interpretation of pathology and cervical invation results of endometrial cancer.Methods The related medical records data of 1135 patients with endometrial cancer treated in the Affiliated Banan Hospital of Chongqing Medical University and Anyue County People’s Hospital from January 2012 to December 2023 were included.The preoperative imaging,histology and postoperative histology conducted the classification,grading and statistically comparison.Results The two methods by adopting diagnostic curettage or hysteroscopic diagnostic curettage sampling had certain proportions of underestimate of overestimate in the interpretation of preoperative pathological grading and histological typing.The preoperative tissues obtained by these two sampling methods in the coincidence rates of the pathological grading and histological typing had no statistically significant difference(P>0.05).The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),positive likelihood ratio(+LR),negative likelihood ratio(-LR)and accuracy of diagnostic curettage in judging cervical invasion were 56.96%,85.34%,34.62%,93.57%,3.89,0.46,and 81.94%respectively,and which in diagnostic hysteroscopic curettage combined with MRI were 73.08%,82.86%,36.54%,95.80%,4.26,0.32 and 81.69%,respectively.Conclusion The hysteroscopic diagnostic curettage could not increase the accuracy of histological typing and pathological grading of endometrial cancer.The hysteroscopic diagnostic curettage combined with MRI examination could more precisely evaluate the cervical invasion situation,guide the operation excision mode for cervix,peripheral tissues and lymph node and range selection.

关 键 词：子宫内膜癌 宫腔镜检查 病理学检查 核磁共振成像 

分 类 号：R713.4[医药卫生—妇产科学]