Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel(1).
Department of Pathology, Kaplan Medical Center, Rehovot, Israel.
Gynecol Oncol. 2015 Feb;136(2):254-7. doi: 10.1016/j.ygyno.2014.12.014. Epub 2014 Dec 16.
The reported frequency of malignant or premalignant changes confined to endometrial polyps (EP) is 0.5-6%. The management of atypical endometrial hyperplasia (AEH) confined to EP is not yet established. Recently, an alternative pathological nomenclature has emerged using the term endometrial intraepithelial neoplasia (EIN) instead of atypia. The objective of this study was to evaluate the safety of conservative hysteroscopic resection of endometrial polyps with AEH or EIN.
Retrospective cohort study of all cases of hysteroscopic resections of EP was performed at a single center between the years 2000-2011. All patients with a pathologic diagnosis of AEH in EP were included. A post-hoc revision of the pathologic specimens was made according to the EIN classification.
Of the 32 patients with AEH in EP, 25 had normal endometrial curetting. Even with AEH confined to EP, 12 cases (48%) showed AEH (11 cases) or carcinoma (1 case) in the hysterectomy specimens. EIN in EP (14 cases) was correlated with 57% of diagnosis of EIN or carcinoma in the uterus; whereas in the absence of EIN in EP only 1 of 9 cases showed EIN in the final pathologic specimen (p=0.002), and none with carcinoma, which yields a PPV of 14% and a NPV of 100%.
The diagnosis of EIN in EP may be a better predictor than AEH for endometrial involvement with malignant or pre-malignant neoplasms. The safety of conservative hysteroscopic resection of EP with AEH/EIN is questioned.
据报道，局限于子宫内膜息肉（EP）的恶性或癌前病变的发生率为 0.5-6%。局限于 EP 的不典型子宫内膜增生（AEH）的处理方法尚未确定。最近，一种替代的病理命名法已经出现，使用术语子宫内膜上皮内瘤变（EIN）代替不典型性。本研究的目的是评估保守性宫腔镜切除 AEH 或 EIN 局限于 EP 的安全性。
对 2000 年至 2011 年在一家中心进行的所有 EP 宫腔镜切除术的病例进行回顾性队列研究。所有 EP 中诊断为 AEH 的患者均被纳入研究。根据 EIN 分类对病理标本进行了回顾性修订。
在 32 例 EP 中 AEH 的患者中，25 例行正常子宫内膜刮宫术。即使 AEH 局限于 EP，12 例（48%）在子宫切除标本中发现 AEH（11 例）或癌（1 例）。EP 中的 EIN（14 例）与 57%的子宫中 EIN 或癌的诊断相关；而在 EP 中无 EIN 的情况下，9 例中有 1 例最终病理标本中出现 EIN（p=0.002），且无癌，其阳性预测值为 14%，阴性预测值为 100%。
与 AEH 相比，EP 中的 EIN 诊断可能是子宫内膜恶性或癌前肿瘤受累的更好预测指标。AEH/EIN 局限于 EP 的宫腔镜保守性切除术的安全性受到质疑。
