Mikuta J J
Division of Gynecologic Oncology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
Cancer. 1995 Nov 15;76(10 Suppl):2041-3. doi: 10.1002/1097-0142(19951115)76:10+<2041::aid-cncr2820761322>3.0.co;2-z.
Preoperative examination of a patient for whom a diagnosis of endometrial cancer has been made by office biopsy or dilatation and curettage includes careful history taking and physical examination, with emphasis on the pelvic examination, blood tests, and imaging evaluations of the pelvis, abdomen and chest, and other specific studies related to medical operability. The primary approach to endometrial cancer is surgery, which has been used for staging and treatment since the adoption of the Federation of Obstetrics and Gynecology system in 1988. Pilot studies and the Gynecologic Oncology Group have researched this system extensively and have emphasized the findings that could be defined only by pathologic study of the uterus, adnexa, retroperitoneal lymph nodes, and peritoneal cytologic findings. Preoperative endocervical evaluation is no longer necessary unless gross invasion of the cervix is suspected. However, initial histologic findings can identify patients at high risk, that is, those with high grade adenocarcinomas, clear cell carcinomas, adenosquamous carcinomas, and papillary serous adenocarcinomas. Intraoperative pathologic evaluation of the uterus by frozen section, which reveals depth of invasion into the myometrium and correlation with tumor grade, can identify patients for whom lymph node sampling should be performed.
对于经门诊活检或刮宫诊断为子宫内膜癌的患者，术前检查包括详细的病史采集和体格检查，重点是盆腔检查、血液检查、盆腔、腹部和胸部的影像学评估，以及与手术可操作性相关的其他特定检查。子宫内膜癌的主要治疗方法是手术，自1988年采用妇产科联合会系统以来，手术一直用于分期和治疗。初步研究和妇科肿瘤学组对该系统进行了广泛研究，并强调了只有通过对子宫、附件、腹膜后淋巴结和腹腔细胞学检查的病理研究才能确定的结果。除非怀疑宫颈有明显侵犯，否则术前宫颈评估不再必要。然而，初始组织学检查结果可以识别高危患者，即那些患有高级别腺癌、透明细胞癌、腺鳞癌和乳头状浆液性腺癌的患者。术中通过冰冻切片对子宫进行病理评估，可揭示肌层浸润深度及与肿瘤分级的相关性，从而确定应进行淋巴结采样的患者。
