Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Int J Gynaecol Obstet. 2010 Aug;110(2):89-92. doi: 10.1016/j.ijgo.2010.03.016. Epub 2010 May 10.
Precise preoperative diagnosis of minimal deviation adenocarcinoma (MDA) of the uterine cervix is often difficult because the histological features of MDA closely resemble those of normal cervical glands.
To review the developments in the diagnosis and treatment of MDA over the past 35 years.
We performed a meta-analysis of all case reports published in the English and Chinese languages between 1975 and 2009 that included a histopathologic diagnosis of MDA. Pooled odds ratios and 95% CIs were calculated for comparisons and analyzed.
The histopathologic diagnosis of MDA remains difficult and is currently based on antigen detection by immunohistochemistry. Cytologic assessment and routine biopsy have low detection rates for MDA. Cross-sectional imaging techniques are helpful but a deep cervical biopsy or cervical conization is necessary for a definitive diagnosis. The mean survival is about 5 years for patients with stage I, 38.1 months for patients with stage II, 22.8 months for patients with stage III, and 5.4 months for patients with stage IV MDA.
Early diagnosis and treatment are key to improving prognosis and survival in patients with MDA.
由于宫颈微小偏离性腺癌(MDA)的组织学特征与正常宫颈腺体非常相似,因此准确的术前诊断往往很困难。
回顾过去 35 年来 MDA 的诊断和治疗进展。
我们对 1975 年至 2009 年间发表的所有以 MDA 的组织病理学诊断为英文和中文的病例报告进行了荟萃分析。对比较和分析进行了汇总优势比和 95%CI 的计算。
MDA 的组织病理学诊断仍然困难,目前基于免疫组织化学的抗原检测。细胞学评估和常规活检对 MDA 的检出率较低。横断面成像技术有帮助,但明确诊断需要进行深部宫颈活检或宫颈锥切术。Ⅰ期患者的平均生存时间约为 5 年,Ⅱ期患者为 38.1 个月,Ⅲ期患者为 22.8 个月,Ⅳ期患者为 5.4 个月。
早期诊断和治疗是改善 MDA 患者预后和生存率的关键。