Bradley William H, Boente Matthew P, Brooker Doris, Argenta Peter A, Downs Levi S, Judson Patricia L, Carson Linda F
Department of Obstetrics, Gynecology and Women's Health, Division of Gynecology Oncology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Obstet Gynecol. 2004 Nov;104(5 Pt 1):1030-3. doi: 10.1097/01.AOG.0000143263.19732.18.
To estimate the effect of preoperative diagnostic hysteroscopy on peritoneal cytology in patients with endometrial cancer.
A total of 256 charts were reviewed. Two cohorts were established based on diagnosis by hysteroscopy or blind endometrial sampling via either endometrial biopsy or dilatation and curettage (D&C). Malignant or suspicious peritoneal cytology was the primary outcome. Cohorts were compared using logistic regression to correct for potential confounders of stage and grade.
A total of 204 cases were diagnosed by endometrial biopsy or D&C, whereas 52 were identified by hysteroscopy. In the endometrial biopsy or D&C arm, 14 of 204 (6.9%) patients had malignant or suspicious cytology compared with 7 of 52 (13.5%) patients in the hysteroscopy arm (P = .15). After logistic regression controlling for stage and grade, the odds ratio for positive cytology after hysteroscopy was 3.88 (95% confidence interval 1.11,13.6; P = .03). Four of the 52 (7.7%) cases diagnosed by hysteroscopy were stage IIIA due to cytology alone compared with 3 of the 204 (1.4%) cases diagnosed by endometrial biopsy or D&C (P = .03).
Hysteroscopy appears to be associated with an increased rate of malignant cytology after controlling for confounders of stage and grade. Further, there appears to be an association between hysteroscopy and upstaging patients due to cytology alone.
II-2.
评估术前诊断性宫腔镜检查对子宫内膜癌患者腹膜细胞学的影响。
共查阅256份病历。根据宫腔镜检查诊断或通过子宫内膜活检或刮宫术（D&C）进行盲目子宫内膜取样建立两个队列。恶性或可疑腹膜细胞学是主要结局。使用逻辑回归比较队列，以校正分期和分级的潜在混杂因素。
204例通过子宫内膜活检或D&C诊断，而52例通过宫腔镜检查确诊。在子宫内膜活检或D&C组中，204例患者中有14例（6.9%）有恶性或可疑细胞学检查结果，而宫腔镜检查组中52例患者中有7例（13.5%）有此结果（P = 0.15）。在对分期和分级进行逻辑回归控制后，宫腔镜检查后细胞学阳性的比值比为3.88（95%置信区间1.11,13.6；P = 0.03）。仅因细胞学检查，52例经宫腔镜检查诊断的病例中有4例（7.7%）为IIIA期，而204例经子宫内膜活检或D&C诊断的病例中有3例（1.4%）为IIIA期（P = 0.03）。
在控制分期和分级的混杂因素后，宫腔镜检查似乎与恶性细胞学检查率增加有关。此外，宫腔镜检查与仅因细胞学检查而使患者分期升高之间似乎存在关联。
II-2。
