Dueholm M, Hjorth I M D, Dahl K, Ørtoft G
Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark.
Department of Gynecology and Obstetrics, Horsens Hospital, Horsens, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2020 Aug;251:173-179. doi: 10.1016/j.ejogrb.2020.05.010. Epub 2020 May 11.
To evaluate and compare the diagnostic efficiency of outpatient endometrial sampling (OES) and hysteroscopic resectoscope-directed biopsies (HY) to distinguish between endometrial cancer (EC) and atypical hyperplasia (AH) and to assess tumor type and grade (histotype) in women with EC.
Patients with AH or EC (n = 266) among 1013 patients consecutively referred because of postmenopausal bleeding were included. Identification of EC versus AH, and unfavorable tumor types (endometrioid grade 3 or non-endometrioid tumors) using OES and HY was compared to final histopathology at hysterectomy. AH or EC were identified by OES in 184 patients and by HY in212.
OES had only sufficient tissue samples in 72.7% of intended samples. Even when OES did provide sufficient material, addition of HY was a better technique than OES alone to distinguish between EC and AH, with an AUC of 95.9% and 79.8%; sensitivity of 97.4% and 64.6% and a specificity of 94.4% and 95.0%, respectively (p = 0.008). AH was falsely diagnosed with OES in 58 (35.4%) of 164 women with a final diagnose of EC. A final diagnosis of stage 1b or more was seen in 22 of these 58 women, while 5 of 194 patients with EC all stage 1a grade 1 had AH by HY. HY had higher correlation in assessment of tumor type and grade than OES, but OES and HY had comparable AUC of 90.3% and 92.4% for identification of unfavorable tumors when tumor histotype was successfully identified. Regarding identification of unfavorable tumors (n = 57), a successfully assessment of histotype by OES combined with HY in women without successfully diagnosed histotype by OES alone had AUC of 91.3%.
Addition of HY may improve diagnosis when preoperative OES identifies AH or is insufficient for explicit diagnosis of tumor type and grade. However, there is limited benefit of the addition of HY in the presence of definite diagnosis of grade 1-2 endometrioid tumors by OES.
评估并比较门诊子宫内膜取样（OES）和宫腔镜电切镜引导下活检（HY）在鉴别子宫内膜癌（EC）和非典型增生（AH）方面的诊断效率，以及评估EC患者的肿瘤类型和分级（组织学类型）。
纳入1013例因绝经后出血连续转诊患者中的AH或EC患者（n = 266）。将使用OES和HY鉴别EC与AH以及不良肿瘤类型（子宫内膜样3级或非子宫内膜样肿瘤）的结果与子宫切除时的最终组织病理学结果进行比较。184例患者通过OES确诊为AH或EC，212例通过HY确诊。
OES仅在72.7%的预期样本中获取了足够的组织样本。即使OES确实提供了足够的材料，联合使用HY也比单独使用OES能更好地区分EC和AH，其曲线下面积（AUC）分别为95.9%和79.8%；敏感性分别为97.4%和64.6%，特异性分别为94.4%和95.0%（p = 0.008）。在最终诊断为EC的164例女性中，有58例（35.4%）被OES误诊为AH。在这58例女性中，有22例最终诊断为1b期或更高分期，而在194例EC均为1a期1级的患者中，有5例通过HY诊断为AH。HY在肿瘤类型和分级评估方面的相关性高于OES，但当肿瘤组织学类型成功确定时，OES和HY在识别不良肿瘤方面的AUC相当，分别为90.3%和92.4%。对于识别不良肿瘤（n = 57），在未通过OES单独成功诊断组织学类型的女性中，OES联合HY成功评估组织学类型的AUC为91.3%。
当术前OES诊断为AH或不足以明确诊断肿瘤类型和分级时，联合使用HY可能会改善诊断。然而，在OES已明确诊断为1 - 2级子宫内膜样肿瘤的情况下，联合使用HY的益处有限。
