Horwitz R I, Feinstein A R, Vidone R A, Sommers S C, Robboy S J
JAMA. 1981 Sep 25;246(13):1425-7.
The slides of 233 patients included in a case-control study of estrogens and endometrial cancer were reviewed to determine how often endometrial cancer was misdiagnosed and whether patients with uterine cancer had other coexistent endometrial diseases. Reasonably close agreements were found among the original diagnoses and those of three additional reviewers (the total range of disagreements among all pathologists was from 2% to 16%). Proliferative and hyperplastic endometrium coexisted in many specimens from patients with endometrial cancer, and especially in those who had used estrogen replacement therapy. In contrast, estrogen therapy had seldom been used by patients whose cancers were not accompanied by these proliferative and hyperplastic lesions. In addition, these changes were found significantly more often in women with grade 1 cancers than grade 2 or 3 cancers. We conclude from these data that diagnostic misclassification is uncommon and that coexistent proliferative and hyperplastic lesions occur frequently, especially among women with grade 1 cancers. The data also suggest that the frequent finding of grade 1 cancer in estrogen users is due to bleeding that results from the stimulated coexistent benign proliferating endometrium.
对纳入雌激素与子宫内膜癌病例对照研究的233例患者的切片进行了复查，以确定子宫内膜癌被误诊的频率，以及子宫癌患者是否存在其他并存的子宫内膜疾病。发现最初诊断与另外三位审阅者的诊断之间存在相当接近的一致性（所有病理学家之间的分歧总范围为2%至16%）。在许多子宫内膜癌患者的标本中，尤其是那些使用过雌激素替代疗法的患者，增殖性和增生性子宫内膜并存。相比之下，癌症未伴有这些增殖性和增生性病变的患者很少使用雌激素疗法。此外，这些变化在1级癌症女性中比在2级或3级癌症女性中更常见。从这些数据中我们得出结论，诊断错误分类并不常见，并存的增殖性和增生性病变经常出现，尤其是在1级癌症女性中。数据还表明，雌激素使用者中频繁发现1级癌症是由于受刺激的并存良性增殖性子宫内膜导致的出血。
