Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, China.
Institute for Intelligent Healthcare, Tsinghua University, Beijing, China.
BMC Cancer. 2022 Oct 25;22(1):1094. doi: 10.1186/s12885-022-10137-x.
This study observed and described the morphological characteristics of the endometrium of the resected uterus using confocal laser endomicroscopy. This included benign endometrium, non-atypical endometrial hyperplasia, atypical endometrial hyperplasia, and endometrial carcinoma, thereby laying a foundation for finding the precise localization and resection of endometrial lesions, given the feasibility of confocal laser endomicroscopy-assisted hysteroscopy.
This prospective study included 32 patients who underwent hysterectomy. We used confocal laser endomicroscopy to observe the endometrium of resected uteruses and described the characteristics of endometrium in different states by comparing histopathological findings (primary objects). The secondary objects of observation were the myometrium, endocervical canal, and surface of the external os of the cervix.
A total of 32 patients who underwent hysterectomy for different diseases were included: 9 with endometrial carcinoma (5 with endometrioid carcinoma, 1 with endometrial serous carcinoma, 2 with clear cell carcinoma, and 1 with carcinosarcoma), 2 with atypical endometrial hyperplasia, 9 with benign diseases, 7 with cervical cancer, and 5 with ovarian cancer and borderline tumor. The dynamic images of the endometrium were observed and recorded using probe-based confocal laser endomicroscopy (pCLE). Considering histopathology as the gold standard, the diagnostic concordance rate of pCLE was 96.9% in patients with endometrial carcinoma and precancerous lesions and 100% in patients with endometrial carcinoma.
Confocal laser endomicroscopy provides real-time high-resolution images of the benign endometrium and endometrial lesions. Compared with histopathology, confocal laser endomicroscopy has high diagnostic accuracy and may become an auxiliary examination tool for hysteroscopy, as it is useful for early identification of endometrial lesions, real-time diagnosis of tumor, and detection of tumor boundaries for complete tumor resection. These findings can lay a foundation for the feasible use of fertility-sparing local excision of tumor lesions by hysteroscopy.
本研究通过共聚焦激光内窥镜观察和描述了切除子宫的子宫内膜的形态特征。这包括良性子宫内膜、非典型子宫内膜增生、不典型子宫内膜增生和子宫内膜癌，从而为发现子宫内膜病变的精确定位和切除奠定了基础，因为共聚焦激光内窥镜辅助宫腔镜检查具有可行性。
本前瞻性研究纳入了 32 例行子宫切除术的患者。我们使用共聚焦激光内窥镜观察切除子宫的子宫内膜，并通过比较组织病理学发现（主要对象）来描述不同状态下子宫内膜的特征。观察的次要对象是子宫肌层、宫颈内口和宫颈外口表面。
共纳入因不同疾病行子宫切除术的 32 例患者：9 例子宫内膜癌（5 例子宫内膜样癌、1 例子宫内膜浆液癌、2 例透明细胞癌和 1 例癌肉瘤）、2 例不典型子宫内膜增生、9 例良性疾病、7 例宫颈癌、5 例卵巢癌和交界性肿瘤。使用基于探头的共聚焦激光内窥镜（pCLE）观察和记录子宫内膜的动态图像。考虑到组织病理学作为金标准，pCLE 在子宫内膜癌和癌前病变患者中的诊断符合率为 96.9%，在子宫内膜癌患者中的诊断符合率为 100%。
共聚焦激光内窥镜提供了良性子宫内膜和子宫内膜病变的实时高分辨率图像。与组织病理学相比，共聚焦激光内窥镜具有较高的诊断准确性，可能成为宫腔镜检查的辅助检查工具，因为它有助于早期识别子宫内膜病变、实时诊断肿瘤以及检测肿瘤边界以实现肿瘤的完全切除。这些发现为宫腔镜下可行的保留生育功能的肿瘤局部切除奠定了基础。
