Wang Xin-yu, Pan Zi-min, Xie Xing
Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Jul;44(7):518-21.
To evaluate accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with clinical stage I endometriod adenocarcinoma for lymphadenectomy.
Clinic-pathological data were retrospectively collected from 687 patients with clinical stage I endometriod adenocarcinoma who underwent operation in Women's Hospital, Zhejiang University School of Medicine from January 1999 to December 2008. According to postoperative histology diagnosis, accuracy of preoperative tumor grade by curettage and depth of myometrial invasion by intraoperative gross examination was evaluated, and clinic-pathological factors associated with accuracy were analyzed.
Sensitivity, specificity, accuracy, false negative rate, false positive rate, and positive and negative predictive value for the prediction of needing for intraoperative lymphadenectomy in patients with clinical stage I endometriod adenocarcinoma were 70.4%, 80.2%, 77.6%, 12.0%, 43.0%, 57.0% and 88.0%, respectively. Analysis of muti-factors shown that patient age, tumor size, lymph node metastasis and extrauterine spread lesions were independent factors affected the accuracy of prediction (P < 0.05).
Prediction of needing for lymphadenectomy by preoperative tumor grade and intraoperative gross examination of myometrial invasion is reliable in clinical stage I endometriod adenocarcinoma patients, while there is a highly false negative rate in prediction of not needing for lymphadenectomy, while other prognostic factors such as patient age, tumor size, lymph node metastasis and extrauterine spread lesion should be together considered.
评估临床I期子宫内膜样腺癌患者术前肿瘤分级及术中子宫肌层浸润大体检查对于淋巴结清扫术的准确性。
回顾性收集1999年1月至2008年12月在浙江大学医学院附属妇产科医院接受手术的687例临床I期子宫内膜样腺癌患者的临床病理资料。根据术后组织学诊断，评估刮宫术前肿瘤分级及术中大体检查子宫肌层浸润深度的准确性，并分析与准确性相关的临床病理因素。
临床I期子宫内膜样腺癌患者预测术中需要行淋巴结清扫术的敏感性、特异性、准确性、假阴性率、假阳性率、阳性预测值和阴性预测值分别为70.4%、80.2%、77.6%、12.0%、43.0%、57.0%和88.0%。多因素分析显示，患者年龄、肿瘤大小、淋巴结转移及宫外播散病灶是影响预测准确性的独立因素（P<0.05）。
对于临床I期子宫内膜样腺癌患者，术前肿瘤分级及术中子宫肌层浸润大体检查预测是否需要行淋巴结清扫术具有一定可靠性，但预测不需要行淋巴结清扫术时假阴性率较高，同时应综合考虑患者年龄、肿瘤大小、淋巴结转移及宫外播散病灶等其他预后因素。
