Alwafai Zaher, Reichert Verena M C, Spring Paula, Zygmunt Marek, Köhler Günter
Department of Obstetrics and Gynecology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany.
J Clin Med. 2024 Jul 11;13(14):4048. doi: 10.3390/jcm13144048.
: There are conflicting data regarding the detection rate of high-risk uterine sarcoma (HRUS) by endometrial biopsy. In addition, there are no studies in the literature on its impact on the chosen surgical approach and survival. : This study includes 415 patients with HRUS. Of these, 178 (42.9%) patients had undergone endometrial biopsy. We analyzed the detection rate of endometrial biopsy and its impact on surgical approach and survival data. : Correct specific histologic diagnosis was achieved in only 30.0% of LMS and 33.3% of HGESS/UUS. Other uterine sarcoma, unspecified malignant mesenchymal tumor, carcinosarcoma or carcinoma were found in 45% of LMS and 78.2% of HGESS/UUS. As a result of the histologic findings, the rate of inadequate surgery was reduced by up to 19.9%. As tumor morcellation was performed significantly less often with biopsy (32.5% with vs. 55.4% without biopsy, < 0.001), the locoregional recurrence-free interval remained unaffected between the two groups = 0.81). This is obviously an advantage of biopsy, although it does not affect the local recurrence rate in morcellated patients. : Indicated endometrial biopsy is an important step in the diagnosis of HRUS, despite its low detection rate. It helps to avoid inappropriate surgical procedures but does not affect OS.
关于子宫内膜活检对高危子宫肉瘤(HRUS)的检出率,存在相互矛盾的数据。此外,文献中尚无关于其对所选手术方式和生存率影响的研究。
本研究纳入了415例HRUS患者。其中,178例(42.9%)患者接受了子宫内膜活检。我们分析了子宫内膜活检的检出率及其对手术方式和生存数据的影响。
仅30.0%的平滑肌肉瘤(LMS)和33.3%的高级别子宫内膜间质肉瘤/未分化子宫肉瘤(HGESS/UUS)获得了正确的特定组织学诊断。在45%的LMS和78.2%的HGESS/UUS中发现了其他子宫肉瘤、未指定的恶性间叶肿瘤、癌肉瘤或癌。由于组织学检查结果,手术不充分率降低了19.9%。由于活检后进行肿瘤粉碎术的频率显著降低(活检组为32.5%,未活检组为55.4%,<0.001),两组间的无局部区域复发生存期未受影响(P=0.81)。这显然是活检的一个优势,尽管它不影响接受粉碎术患者的局部复发率。
尽管子宫内膜活检的检出率较低,但对于HRUS的诊断而言,有指征的子宫内膜活检是重要的一步。它有助于避免不恰当的手术操作,但不影响总生存期(OS)。