Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Department of Obstetrics and Gynecology, St. Vincent's Hospital, Catholic University College of Medicine, Suwon, Korea.
J Gynecol Oncol. 2020 Jul;31(4):e51. doi: 10.3802/jgo.2020.31.e51. Epub 2020 Feb 7.
To compare the diagnostic accuracy of dilatation and curettage (D&C) versus endometrial aspiration biopsy in follow-up evaluation of patients treated with progestin for endometrial hyperplasia (EH).
A prospective multicenter study was conducted from 2015 to 2018. Patients with EH were treated with progestin, one of the following three treatment regimens: oral medroxyprogesterone acetate (MPA) 10 mg/day for 14 days per cycle, continuous MPA 10 mg/day or the levonorgestrel-releasing intrauterine system (LNG-IUS). At 3 or 6 months of treatment, endometrial tissues were obtained via 2 methods in each patient: aspiration biopsy, followed by D&C. The primary outcome was the consistency of the histologic results between the 2 methods. The secondary outcome was the regression rate at 6 months of treatment.
The study population comprised 65 patients (55 with non-atypical hyperplasia, 10 with atypical hyperplasia). During the follow-up, a comparison of the pathologic results from aspiration biopsy and D&C was carried out for the 65 cases. Thirty-eight cases were diagnosed as EH by D&C. Among these, only 24 were diagnosed with EH from aspiration biopsy, for a diagnostic concordance of 63.2% (κ=0.59). Forty-four patients were followed up at 6 months, and the regression rate was 31.8% (14/44). Responses were obtained for 41.7% (5/12) of the cyclic MPA group, 58.3% (7/12) of the continuous MPA group and 10% (2/20) of the LNG-IUS group.
As a follow-up evaluation of patients treated with progestin for EH, aspiration biopsy is less accurate than D&C and might not be a reliable method.
ClinicalTrials.gov Identifier: NCT02412072.
比较在孕激素治疗子宫内膜增生（EH）患者的随访中，扩张刮宫术（D&C）与子宫内膜吸引活检在诊断中的准确性。
这是一项 2015 年至 2018 年进行的前瞻性多中心研究。EH 患者接受孕激素治疗，采用以下三种治疗方案之一：每周期 10mg 醋酸甲羟孕酮（MPA）口服 14 天，连续 MPA 10mg/天或左炔诺孕酮释放宫内节育系统（LNG-IUS）。在治疗 3 或 6 个月时，每位患者通过两种方法获得子宫内膜组织：吸引活检，然后进行 D&C。主要结局是两种方法的组织学结果的一致性。次要结局是 6 个月时的治疗缓解率。
研究人群包括 65 例患者（55 例非典型增生，10 例不典型增生）。在随访期间，对 65 例患者的吸引活检和 D&C 病理结果进行了比较。38 例 D&C 诊断为 EH。其中，仅 24 例通过吸引活检诊断为 EH，诊断一致性为 63.2%（κ=0.59）。44 例患者随访至 6 个月，缓解率为 31.8%（44/138）。周期性 MPA 组缓解率为 41.7%（5/12），连续 MPA 组为 58.3%（7/12），LNG-IUS 组为 10%（2/20）。
作为孕激素治疗 EH 患者的随访评估，吸引活检不如 D&C 准确，可能不是一种可靠的方法。
ClinicalTrials.gov 标识符：NCT02412072。
