Asano Keita, Unno Hikari, Kubota Satoshi, Matsuzaki Satoko, Sumikura Tomoko, Iwamiya Tadashi, Shimazu Kohki, Fushimi Hiroaki, Takemura Masahiko, Morishige Ken-Ichiro
Department of Obstetrics and Gynecology, Osaka University, Osaka, JPN.
Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka, JPN.
Cureus. 2025 Apr 8;17(4):e81880. doi: 10.7759/cureus.81880. eCollection 2025 Apr.
Introduction This study aimed to evaluate the diagnostic accuracy of aspiration biopsy alone versus a combined aspiration biopsy and full curettage for endometrial hyperplasia, focusing on concerns about the underestimation of malignancy with aspiration alone. Methods We compared the pathological diagnoses obtained from aspiration biopsy and full curettage with postoperative diagnoses in 87 surgically treated cases of endometrial hyperplasia at our center (August 2013 to September 2023). The diagnostic accuracy of each preoperative histology method was compared against the final postoperative diagnosis for cases where intraoperative rapid pathology was performed, either with aspiration biopsy alone or with combined aspiration and curettage. Results Aspiration biopsy alone diagnosed 47 cases (54.0%) as endometrial intraepithelial neoplasia (EIN) and 40 cases (46.0%) as endometrial hyperplasia without atypia. Preoperative histological diagnosis was performed by aspiration alone in 63 cases (72.4%) and by aspiration plus full curettage in 24 cases (27.6%). The rate of postoperative upgrade to endometrial cancer was significantly lower when both methods were used (42.9% vs. 16.7%; p = 0.026, Fisher's exact test). Among 33 cases with intraoperative rapid pathology, the upgrade rate was lower in the combined method group than in the aspiration-only group, though the difference was not statistically significant (30.8% vs. 14.3%; p = 0.64). Conclusions Incorporating full curettage alongside aspiration biopsy improves diagnostic accuracy for endometrial hyperplasia, reducing the risk of misdiagnosis and aiding appropriate treatment decisions. These results emphasize the importance of considering both biopsy methods in preoperative diagnosis and management.
引言 本研究旨在评估单纯刮宫活检与刮宫活检联合全面刮宫术对子宫内膜增生的诊断准确性，重点关注单纯刮宫活检对恶性肿瘤低估的问题。方法 我们比较了在本中心（2013年8月至2023年9月）接受手术治疗的87例子宫内膜增生病例中，刮宫活检和全面刮宫术获得的病理诊断与术后诊断。对于术中进行快速病理检查的病例，比较了每种术前组织学方法的诊断准确性，这些病例采用了单纯刮宫活检或刮宫活检联合全面刮宫术。结果 单纯刮宫活检诊断为子宫内膜上皮内瘤变（EIN）47例（54.0%），诊断为无异型性的子宫内膜增生40例（46.0%）。术前组织学诊断采用单纯刮宫活检63例（72.4%），采用刮宫活检联合全面刮宫术24例（27.6%）。两种方法联合使用时，术后升级为子宫内膜癌的发生率显著降低（42.9%对16.7%；p = 0.026，Fisher精确检验）。在33例术中进行快速病理检查的病例中，联合方法组的升级率低于单纯刮宫组，尽管差异无统计学意义（30.8%对14.3%；p = 0.64）。结论 刮宫活检联合全面刮宫术可提高子宫内膜增生的诊断准确性，降低误诊风险，有助于做出适当的治疗决策。这些结果强调了在术前诊断和管理中考虑两种活检方法的重要性。
