Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beongil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
Diagn Pathol. 2021 Jan 14;16(1):7. doi: 10.1186/s13000-020-01065-0.
To compare the diagnostic accuracy of aspiration biopsy and dilatation and curettage (D&C) in patients diagnosed with endometrial hyperplasia prior to hysterectomy.
We retrospectively reviewed medical records of 250 patients diagnosed with endometrial hyperplasia by endometrial sampling between July 2003 and March 2020. Endometrial sampling was performed by aspiration biopsy (n = 150) or D&C (n = 100), followed by hysterectomy within 6 months. Pathological findings of hysterectomy specimens of the two groups were compared to preoperative findings.
The overall diagnostic concordance between endometrial sampling specimen including D&C and aspiration biopsy, and hysterectomy specimen was 51.0% (51/100) and 41.3% (62/150), respectively. Patients whose preoperative specimen was obtained by D&C were upgraded less significantly than those who underwent aspiration biopsy (21.0% vs 36.7%; P = 0.008). In particular, significantly fewer patients were upgraded after D&C than after aspiration biopsy in hyperplasia without atypia (12.5% vs 29.0%; P = 0.028). In addition, when the final pathological upgrade rate to endometrial carcinoma was evaluated between the two methods of endometrial sampling, significantly fewer cases were noted after D&C than after aspiration biopsy (15.0% vs 27.3%; P = 0.022).
In our study, D&C more accurately reflected the final diagnosis in patients with endometrial hyperplasia than aspiration biopsy based on the histological examination of hysterectomy specimens. When considering the management strategy for women with an endometrial hyperplasia diagnosis obtained by aspiration biopsy, physicians should consider the significant rate of upgraded diseases with this method of endometrial sampling.
比较刮宫术（D&C）与抽吸活检在诊断为子宫内膜增生症患者术前诊断中的准确性。
我们回顾性分析了 2003 年 7 月至 2020 年 3 月期间经子宫内膜取样诊断为子宫内膜增生症的 250 例患者的病历。通过抽吸活检（n=150）或 D&C（n=100）进行子宫内膜取样，6 个月内进行子宫切除术。比较两组患者的子宫切除标本的病理发现与术前发现。
D&C 和抽吸活检的子宫内膜取样标本与子宫切除标本的总诊断一致性分别为 51.0%（51/100）和 41.3%（62/150）。与抽吸活检相比，D&C 组术前标本升级不明显的患者比例较低（21.0% vs. 36.7%；P=0.008）。特别是在非典型增生的单纯性增生患者中，D&C 组术后升级的患者明显少于抽吸活检组（12.5% vs. 29.0%；P=0.028）。此外，在评估两种子宫内膜取样方法的最终病理升级为子宫内膜癌的发生率时，D&C 组明显少于抽吸活检组（15.0% vs. 27.3%；P=0.022）。
在我们的研究中，与抽吸活检相比，D&C 在基于子宫切除标本的组织学检查时更准确地反映了子宫内膜增生症患者的最终诊断。在考虑通过抽吸活检诊断为子宫内膜增生症的女性的管理策略时，医生应考虑到这种子宫内膜取样方法疾病升级的显著发生率。
