Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing 100044, China.
Chin Med J (Engl). 2010 Dec;123(24):3524-8.
Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.
Two hundred and eighty-seven patients with endometrial carcinoma who were treated in Beijing University People's Hospital, Beijing, China were distributed into 2 groups: Group A (90 patients) was examined using hysteroscopy and directed biopsy, and Group B (197 patients) was examined using fractional dilatation and curettage (D&C). The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared.
In Group A, 97.8% (88/90) of patients were diagnosed pathologically before surgery; the rate was 88.8% (175/197) for Group B. The difference between the 2 groups was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 77.8%, 100%, 100% and 97.6% for Group A and 65.3%, 92.6%, 74.4% and 90.0% for Group B, respectively. The positive peritoneal cytology rate was 5.6% (5/90) in Group A and 6.09% (12/197) in Group B. The difference was not statistically significant (P > 0.05). The 3-year and 5-year overall survival rates were 91.4% (33/36) and 82.4% (14/17) for Group A and 95.6% (87/91) and 86.7% (39/45) for Group B. There were no statistically significant differences between the two groups' survival rates (P > 0.05).
Compared with fractional D&C, hysteroscopy and directed biopsy offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.
诊断性宫腔镜检查和定向活检已广泛用于评估异常子宫出血。我们旨在探讨宫腔镜检查和定向活检在子宫内膜癌诊断中的价值。
将在中国北京北京大学人民医院接受治疗的 287 例子宫内膜癌患者分为 2 组：A 组（90 例）采用宫腔镜检查和定向活检，B 组（197 例）采用分段刮宫术（D&C）。比较两种方法的诊断准确性、阳性腹膜细胞学检出率以及两组的预后。
A 组术前病理诊断率为 97.8%（88/90）；B 组为 88.8%（175/197）。两组差异有统计学意义（P<0.05）。两种方法检测宫颈受累的敏感性、特异性、阳性预测值和阴性预测值分别为 A 组 77.8%、100%、100%和 97.6%，B 组为 65.3%、92.6%、74.4%和 90.0%。A 组阳性腹膜细胞学检出率为 5.6%（5/90），B 组为 6.09%（12/197）。两组差异无统计学意义（P>0.05）。A 组 3 年和 5 年总生存率分别为 91.4%（33/36）和 82.4%（14/17），B 组分别为 95.6%（87/91）和 86.7%（39/45）。两组生存率差异无统计学意义（P>0.05）。
与分段刮宫术相比，宫腔镜检查和定向活检可提高术前病理诊断准确性，更准确地发现子宫内膜癌患者的宫颈受累情况，但不会增加阳性腹膜细胞学检出率或影响患者预后。
