子宫内膜回声不均患者内膜组织病理特点及恶变高危因素分析

 目的 分析子宫内膜回声不均患者的内膜组织病理结果及恶变高危因素，探讨其临床意义。方法 纳入复旦大学附属妇产科医院2015年1月—2018年12月869例经阴道彩色多普勒超声提示内膜回声不均并行宫腔镜检查的患者，总结其病理特点及临床资料，以内膜不典型增生及恶性病变为研究组，以内膜正常及良性病变为对照组采用Logistic回归分析内膜回声不均患者诊断内膜癌前/恶性病变高危因素。结果 宫腔镜下定位活检组织病理结果表明，超声提示子宫内膜回声不均患者中，56.04%（487/869）患者内膜正常，43.96%（382/869）内膜病变，其中，38.55%（335/869）为良性病变，5.41%（47/869）为内膜不典型增生或恶性病变。多因素Logistic回归分析表明，年龄≥50岁（OR：3.498，95% CI：1.209~10.124，P=0.021）、异常子宫出血（OR：2.903，95% CI：1.904~4.425，P<0.001）、内膜厚度≥7 mm（OR：6.411，95% CI：1.921~21.392，P=0.003）是子宫内膜发生癌前或恶性病变的独立高危因素，ROC曲线下面积为0.749。结论 超声提示内膜回声不均是内膜病变的重要预测指标，年龄≥50岁、异常子宫出血、内膜厚度≥7 mm是发生癌前/恶性病变的高危因素。

Histopathology of women with non-uniform endometrial echogenicity and risk factors for atypical endometrial hyperplasia and carcinoma

Objective To explore the clinical meaning of non-uniform endometrium in the diagnosis of endometrial lesions, and the resk factors for atypical endometrial hyperplasia and carcinoma. Methods Totally, 869 patients with non-uniform endometrial echogenicity who underwent hysteroscopy-directed biopsy were enrolled in the Obstetrics and Gynecology Hospital of Fudan University from Jan 2015 to Dec 2018 as the primary cohort. Characteristics were assessed using univariate Logistic regression between patients with and without atypical endometrial hyperplasia and carcinoma (atypical EH+). Multivariate analyses were used to develop the predicting model and create the Receiver Operating Characteristic (ROC) curve. Results Hysteroscopy-directed biopsy and diagnostic curettage showed that 56.04% (487/869) of the patients with non-uniform endometrium had normal endometrium, while 43.96% (382/869) had endometrial lesions with 38.55% (335/869) benign lesions and 5.41% (47/869) atypical EH+. Multivariate Logistic regression analysis showed that age ≥ 50 years old (OR: 3.498, 95%CI: 1.209-10.124, P=0.021), endometrial thickness ≥ 7 mm (OR: 6.411, 95%CI: 1.921-21.392, P=0.003) and abnormal uterine bleeding (AUB) (OR: 2.903, 95%CI: 1.904-4.425, P<0.001) were risk factors for atypical EH+. The model showed good discrimination with area under curve (AUC) of 0.749. Conclusion Non-uniform endometrial echogenicity is clinically meaningful in assessment of atypical EH+ with risk factors of age ≥ 50 years old, AUB and endometrial thickness ≥ 7 mm.