Suh-Burgmann Elizabeth, Hung Yun-Yi, Armstrong Mary Anne
From the Division of Gynecologic Oncology, The Permanente Medical Group, Walnut Creek, California; and Division of Research, Kaiser Permanente Northern California, Oakland, California.
Obstet Gynecol. 2009 Sep;114(3):523-529. doi: 10.1097/AOG.0b013e3181b190d5.
To evaluate whether preoperative dilation and curettage (D&C) lowers the risk of unexpected cancer at hysterectomy.
Women with complex atypical endometrial hyperplasia on sampling from January 2000 to May 2008 who underwent hysterectomy within 6 months were identified using a pathology database. Patient age, sampling procedures, and hysterectomy pathology were recorded. Women were categorized as having either an office biopsy-based evaluation or a curettage-based evaluation. The proportion of women with cancer at surgery was estimated and compared for the two groups.
Of 824 women with complex atypical endometrial hyperplasia on initial sampling, 48% were found to have cancer. For 100 women, cancer was diagnosed preoperatively by additional sampling before hysterectomy. For the remaining 724, 298 (41%) had unexpected cancer at hysterectomy. The diagnosis of complex atypical endometrial hyperplasia was biopsy-based for 531 (73%) and curettage-based for 193 (27%). The risk of cancer for women who had a D&C was significantly lower than for those who had biopsy, but still of concern (30% compared with 45%, P<.001), as was the risk of myometrial invasion (18% compared with 25%, P=.05). Age was strongly correlated to risk of cancer, invasive cancer, and deeply invasive or grade 3 disease.
Dilation and curettage lowered the risk of unexpected cancer compared with biopsy, but 18% of women still had invasive cancer found at hysterectomy. The risk of unexpected cancer is strongly related to age. Dilation and curettage can help detect cancer preoperatively but is not reliable for excluding cancer.
II.
评估术前刮宫术（D&C）是否能降低子宫切除术中意外发现癌症的风险。
利用病理数据库识别出2000年1月至2008年5月间取样显示为复杂性非典型子宫内膜增生且在6个月内接受子宫切除术的女性。记录患者年龄、取样程序和子宫切除术后的病理情况。女性被分为基于门诊活检的评估组或基于刮宫的评估组。估计并比较两组手术时患有癌症的女性比例。
在最初取样显示为复杂性非典型子宫内膜增生的824名女性中，48%被发现患有癌症。对于100名女性，在子宫切除术前通过额外取样术前诊断出癌症。对于其余724名女性，298名（41%）在子宫切除术中发现意外癌症。531名（73%）复杂性非典型子宫内膜增生的诊断基于活检，193名（27%）基于刮宫。接受刮宫术的女性患癌风险显著低于接受活检的女性，但仍令人担忧（分别为30%和45%，P<0.001），肌层浸润风险也是如此（分别为18%和25%，P = 0.05）。年龄与患癌风险、浸润性癌以及深度浸润或3级疾病风险密切相关。
与活检相比，刮宫术降低了意外发现癌症的风险，但仍有18%的女性在子宫切除术中被发现患有浸润性癌。意外发现癌症的风险与年龄密切相关。刮宫术有助于术前检测癌症，但排除癌症并不可靠。
II级
