Lü W, Xie X, Ye D
Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
Zhonghua Yi Xue Za Zhi. 2001 Jul 10;81(13):816-8.
To evaluate the accuracy of diagnosing endometrial hyperplasia (EH) by curettage.
150 cases who had been diagnosed as EH by curettage and received hysterectomy shortly after were studied retrospectively. All of the specimens obtained from curettage and operation underwent pathological examination. The results of pathological diagnosis of these two kinds of specimens were compared. Proliferating cell nuclear antigen (PCNA) expression was examined by immunohistochemistry in 38 cases diagnosed as complex atypical hyperplasia (CAH).
Fifty-three cases were diagnosed as simple hyperplasia (SH), eleven cases as complex hyperplasia (CH), twenty-six cases as simple atypical hyperplasia (SAH), and sixty cases as CAH by curettage. Rediagnosis was made for all patients after hysterectomy. Pathological examination of the specimens from operation diagnosed 65 cases as SH, 7 cases as CH, 15 cases as SAH, 29 cases as CAH, and 34 cases as EC. The general accuracy of histological diagnosis by curettage was 76.7% approximately 92.6%. Coexistence with EC was more common in cases with SAH and CAH than in cases with SH and CH (chi(2) = 26.3, P < 0.01). Coexistence with EC was more common in cases with CAH than in cases with SAH (chi(2) = 9.78, P < 0.005). Among the CAH cases, coexistence with EC was more common in postmenopausal patients than in premenopausal patients (chi(2) = 3.93, P < 0.05). Among the CAH cases, the positive rate of PCNA expression was higher and strength of positivity greater in those cases with EC (Uc = 3.66, P < 0.05).
The accuracy of curettage is rather high in diagnosing SH and relatively low in diagnosing CAH. CAH often coexists with EC. Examination of PCNA expression may help differentiate between CAH and EC.
评估刮宫诊断子宫内膜增生（EH）的准确性。
回顾性研究150例经刮宫诊断为EH且随后不久接受子宫切除术的患者。对所有刮宫及手术获取的标本进行病理检查。比较这两种标本的病理诊断结果。采用免疫组织化学法检测38例诊断为复杂性不典型增生（CAH）患者的增殖细胞核抗原（PCNA）表达。
刮宫诊断为单纯性增生（SH）53例、复杂性增生（CH）11例、单纯性不典型增生（SAH）26例、CAH 60例。子宫切除术后对所有患者重新诊断。手术标本病理检查诊断为SH 65例、CH 7例、SAH 15例、CAH 29例、子宫内膜癌（EC）34例。刮宫组织学诊断的总体准确率约为76.7%至92.6%。SAH和CAH病例中EC共存比SH和CH病例更常见（χ² = 26.3，P < 0.01）。CAH病例中EC共存比SAH病例更常见（χ² = 9.78，P < 0.005）。在CAH病例中，绝经后患者EC共存比绝经前患者更常见（χ² = 3.93，P < 0.05）。在CAH病例中，有EC的病例PCNA表达阳性率更高且阳性强度更大（Uc = 3.66，P < 0.05）。
刮宫诊断SH的准确性较高，诊断CAH的准确性相对较低。CAH常与EC共存。检测PCNA表达可能有助于鉴别CAH和EC。
