Kim Da Hee, Seong Seok Ju, Kim Mi Kyoung, Bae Hyo Sook, Kim Mi La, Yun Bo Seong, Jung Yong Wook, Shim Jeong Yun
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Department of Pathology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
J Gynecol Oncol. 2017 Jan;28(1):e1. doi: 10.3802/jgo.2017.28.e1. Epub 2016 Aug 2.
To determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS).
We conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics.
Twenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation.
To evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.
确定在接受高剂量口服孕激素和左炔诺孕酮宫内节育系统（LNG-IUS）治疗的早期子宫内膜癌（EC）患者中，与刮宫术（D&C）活检相比，微创子宫内膜（EM）抽吸活检在评估治疗效果方面的准确性是否足够。
我们对年龄小于40岁、被诊断为临床IA期、国际妇产科联盟1级或2级子宫内膜样腺癌且希望保留生育能力的患者进行了一项前瞻性观察研究。患者接受醋酸甲羟孕酮500mg/天和LNG-IUS治疗。每3个月评估一次治疗反应。在取出LNG-IUS后进行EM抽吸活检，随后进行D&C。对组织样本进行组织学比较。用κ统计量检查两种检测的诊断一致性率。
从5名患者中获得了28对EM样本。D&C和EM抽吸活检的诊断一致性率为39.3%（κ值=0.26）。在D&C诊断为正常的7个样本中，3个（42.8%）通过EM抽吸活检诊断为正常。在D&C诊断为子宫内膜样腺癌的8个样本中，3个（37.5%）通过EM抽吸活检诊断为子宫内膜样腺癌。在D&C诊断为复杂性EM增生的13个样本中，5个（38.5%）通过EM抽吸活检诊断为EM增生。在通过EM抽吸获得的样本中，46.4%的样本不足以进行组织学评估。
为评估接受高剂量口服孕激素和LNG-IUS治疗的早期EC患者的治疗反应，应在取出LNG-IUS后进行D&C。
