子宫内膜微组织取样活检在子宫内膜病变保留生育功能治疗复查中的应用  

Application of endometrial microscale sampling biopsy in the follow-up of patients with endometrial lesions undergoing fertility-sparing treatment

作　　者：贺淼 冯艺帆 张果[1] 王建六[1] HE Miao;FENG Yifan;ZHANG Guo;WANG Jianliu(Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing,100044,China)

机构地区：[1]北京大学人民医院妇产科,北京1000044

出　　处：《中国妇产科临床杂志》2025年第2期100-102,共3页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：中国研究型医院学会妇产科学专委会科研课题项目(Y2024FH-FCKX06);国家自然科学基金青年项目(82203646)。

摘　　要：目的评估子宫内膜微组织取样活检对子宫内膜癌/非典型增生患者保留生育功能治疗复查中的应用价值,为这一技术在子宫内膜癌筛查的应用推广提供循证医学证据。方法回顾性分析2023年7月至2024年10月于北京大学人民医院行保留生育功能治疗后子宫内膜评估的222例子宫内膜非典型增生/子宫内膜癌患者的临床资料,均接受宫腔镜下子宫内膜活检,且术前应用Li-brush行子宫内膜微组织取样活检,比较子宫内膜微组织取样活检的取样满意率、病理诊断符合率、诊断子宫内膜病变的灵敏度、特异度、阴性预测值及阳性预测值。结果222例患者中,标本满意率为71.2%,保留生育功能治疗后复查患者行子宫内膜微组织活检取样与宫腔镜下子宫内膜活检病理诊断符合率为73.9%(164/222),Kappa值为0.258(95%CI:0.148~0.368),灵敏度为20.5%(15/73),特异度为100%(149/149),阴性预测值为71.9%(149/207),阳性预测值为100%(15/15)。结论子宫内膜微组织取样活检用于子宫内膜病变保留生育功能治疗复查的病理诊断符合率、灵敏度、阴性预测值均较低,不适用于子宫内膜癌/非典型增生保育患者的治疗随访。Objective To evaluate the application of microscale endometrial sampling biopsy in the follow-up of patients with endometrial cancer/atypical hyperplasia undergoing fertility-sparing treatment,and to provide evidence for the selecting the appropriate population for this technique.Methods A retrospective analysis was conducted on the clinical data of 222 patients who underwent atypical hyperplasia/endometrial cancer who underwent endometrial evaluation after fertility-sparing treatment at Peking University People's Hospital between July 2023 and October 2024.All patients underwent hysteroscopic endometrial biopsy,with preoperative microscale endometrial sampling biopsy using the Li-brush.The sample adequacy,pathological diagnostic concordance rate,sensitivity,specificity,negative predictive value(NPV),and positive predictive value(PPV)of the microscale endometrial sampling biopsy for diagnosing endometrial lesions were analyzed.Results Among the 222 patients,the specimen adequacy was 71.2%.The concordance rate was 73.9%(164/222),with a Kappa value of 0.258(95%CI:0.148-0.368).The sensitivity for diagnosing endometrial lesions was 20.5%(15/73),with specificity of 100%(149/149),NPV of 71.9%(149/207),and PPV of 100%(15/15).Conclusions Microscale endometrial sampling biopsy demonstrates relatively low concordance rate,sensitivity,and NPV in the pathological assessment of endometrium after fertility-sparing treatment.It is not recommended for clinical follow-up of endometrial cancer/atypical hyperplasia patients receiving fertility-sparing therapy.

关 键 词：子宫内膜癌筛查 子宫内膜微组织 诊断价值 

分 类 号：R737.33[医药卫生—肿瘤]