Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Chin Med J (Engl). 2009 Aug 20;122(16):1843-6.
Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage I endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage I endometriod adenocarcinoma.
Clinical data of totally 687 patients with clinical stage I endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed.
In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% (281/687) and an upgraded rate of 24.7% (170/687). The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively.
Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage I endometriod adenocarcinoma.
术前肿瘤分级是临床 I 期子宫内膜样腺癌患者初次手术行淋巴结切除术的最重要预测指标之一。然而，术前刮宫术和最终子宫切除术标本之间存在肿瘤分级不一致的情况，其相关因素尚不清楚。本研究旨在评估术前刮宫术肿瘤分级的准确性，以便对临床 I 期子宫内膜样腺癌进行更好的分层管理。
回顾性收集了 687 例经术前刮宫术和初次手术治疗的临床 I 期子宫内膜样腺癌患者的临床资料。与最终子宫切除术标本相比，计算了术前刮宫术肿瘤分级的敏感性、特异性、准确性、阳性预测值和阴性预测值，并分析了其与临床病理参数（包括年龄、绝经状态、子宫位置、病变位置和大小、组织学分级、肌层浸润深度、宫颈浸润、宫外扩散、腹腔细胞学、腹膜后淋巴结转移、血清 CA125 水平和激素受体状态）的相关性。
在最终子宫切除标本中，术前刮宫术分级为 1 级的 259 例患者中，有 139 例升级为 1 级或 2 级；术前刮宫术分级为 2 级的 296 例患者中，有 31 例升级为 3 级，差异率为 40.9%（281/687），升级率为 24.7%（170/687）。3 级的特异性和阴性预测值分别为 90.7%和 89.9%，而 1 级的敏感性和阳性预测值分别为 67.1%和 40.9%。
术前刮宫术肿瘤分级不能准确预测最终组织学结果，特别是在分级为 1 级的患者中。对于临床 I 期子宫内膜样腺癌，似乎有必要进行完全的手术分期。
