Xu Jianying, Rao Xuan, Lu Weiguo, Xie Xing, Wang Xinyu, Li Xiao
Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China.
Cancer Center, Zhejiang University, Hangzhou, China.
Front Oncol. 2022 Jan 27;11:812033. doi: 10.3389/fonc.2021.812033. eCollection 2021.
There was no consensus for management of asymptomatic endometrial polyps (EPs) up to date.
The aim of present study was to determine the risk factors of malignant lesions in EPs diagnosed by ultrasound and establish a noninvasive predictor to decrease unnecessary hysteroscopy for EPs.
We reviewed the records of all consecutive patients who underwent hysteroscopy for EPs in the Women's Hospital School of Medicine Zhejiang University between January 1, 2001 and December 31, 2018. The patients with histological diagnoses of atypical hyperplasia or cancer were defined as malignancy, while the patients with histological diagnoses of benign lesions were randomly selected as benign group according to the ratio of 1:4 (malignancy:benign), matching by age and year of hospitalization. Logistic regression analysis was used to analyze the clinical parameters for predicting malignancy of EPs. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed to find a noninvasive predictor. The sensitivity, specificity, and the receiver operating characteristic curve (ROC) were used for assess the efficacy of the noninvasive predictor. New diagnosed EPs patients received in 2019 were used for verifying the accuracy of the noninvasive predictor.
The age in 15,790 cases of benign lesions was significantly younger than that in 230 malignancy cases (41.97 ± 11.53 year vs 53.31 ± 11.61 years, p <0.001). AUB (OR 7.306, 95%CI 4.927-10.835), large EPs (OR 2.595, 95%CI 1.662-4.052), and blood flow signal in EPs (OR 2.690, 95%CI 1.872-3.866) were independent predictive factors of malignancy in all enrolled patients. A noninvasive predictor for malignancy of EPs was established, through combining with AUB, large polyps and blood flow signal. This predictor presented excellent sensitivity and NPV (91.3 and 95.8%), with acceptable specificity and AUC (0.801). Further validation in new diagnosed EPs also suggested excellent sensitivity and reasonable specificity (100 and 58.5%) of the predictor. Factors such as thickened endometrial thickness, menopause shorter than 10 years, hypertension, obesity and nulliparous were also validated as independent predictors of malignancy in different subgroup analysis.
The noninvasive predictor combined with other risk factors from subgroup analysis would be reliable to distinguish the benign lesions from malignancy for EPs diagnosed by ultrasound.
目前对于无症状子宫内膜息肉（EPs）的管理尚无共识。
本研究旨在确定经超声诊断的EPs中恶性病变的危险因素，并建立一种非侵入性预测指标，以减少EPs不必要的宫腔镜检查。
我们回顾了2001年1月1日至2018年12月31日期间在浙江大学医学院附属妇产科医院因EPs接受宫腔镜检查的所有连续患者的记录。组织学诊断为非典型增生或癌症的患者被定义为恶性病变，而组织学诊断为良性病变的患者则按照1:4的比例（恶性:良性）随机选择作为良性组，根据年龄和住院年份进行匹配。采用逻辑回归分析来分析预测EPs恶性病变的临床参数。进行卡方自动交互检测（CHAID）决策树分析以寻找非侵入性预测指标。使用灵敏度、特异度和受试者工作特征曲线（ROC）来评估非侵入性预测指标的效能。2019年新诊断的EPs患者用于验证非侵入性预测指标的准确性。
15790例良性病变患者的年龄显著低于230例恶性病变患者（41.97±11.53岁 vs 53.31±11.61岁，p<0.001）。异常子宫出血（AUB）（OR 7.306，95%CI 4.927-10.835）、较大的EPs（OR 2.595，95%CI 1.662-4.052）以及EPs中的血流信号（OR 2.690，95%CI 1.872-3.866）是所有纳入患者中恶性病变的独立预测因素。通过结合AUB、较大息肉和血流信号，建立了一种EPs恶性病变的非侵入性预测指标。该预测指标具有出色的灵敏度和阴性预测值（91.3%和95.8%），特异度和曲线下面积（AUC）也可接受（0.801）。在新诊断的EPs中进一步验证也表明该预测指标具有出色的灵敏度和合理的特异度（100%和58.5%）。在不同亚组分析中，子宫内膜增厚、绝经短于10年、高血压、肥胖和未生育等因素也被验证为恶性病变的独立预测因素。
结合亚组分析中的其他危险因素的非侵入性预测指标，对于通过超声诊断的EPs区分良性病变和恶性病变是可靠的。
