Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia

OBJECTIVE: To establish the accuracy of endometrial biopsy with the Cornier pipelle in the diagnosis of endometrial cancer and atypical endometrial hyperplasia in our milieu. MATERIAL AND METHOD: We reviewed 1,535 anatomopathologic reports on endometrial biopsies taken from outpatients using the Cornier pipelle between 1997 and 2000, in pre- and postmenopausal patients with abnormal vaginal bleeding. In 168 patients (10.9%), curettage and/or hysterectomy was subsequently carried out. In these cases, the anatomopathologic reports were compared to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR). RESULTS: Sensitivity was 84.2%, specificity was 99.1%, accuracy was 96.9%, PPV was 94.1%, NPV was 93.7% and LR was 93.5. In 249 cases (16.09%) the material was insufficient for study. CONCLUSION: We determined that endometrial biopsy taken with the Cornier pipelle is, as we practice it, an accurate method for diagnosis of endometrial cancer and its precursor, atypical hyperplasia.     

Pipelle de Cornier~子宫内膜取样器与常规诊刮进行组织学诊断的对照研究

目的:评价Pipelle de Cornier子宫内膜取样器(取样器)获取子宫内膜组织进行组织学诊断的准确性。方法:收集2011年8月至11月解放军总医院妇产科需行诊断性刮宫的245例患者,行常规诊刮前用取样器先获取子宫内膜组织。由同一病理医师进行评估并作出组织学诊断。结果:(1)刮匙法的取材失败率(7.75%)与取样器法(8.98%)比较,无显著差异(P>0.05)。取材失败者主要为绝经后病例。刮匙法与取样器法的标本满意度比较,无显著差异(P>0.05)。(2)病理诊断可对比者219例,诊断符合率93.6%(205/219)。两种取材方法在子宫内膜癌、子宫内膜单纯增生、不典型增生、子宫内膜息肉、子宫内膜炎等病变中的诊断准确率均无显著差异。8例子宫内膜癌患者,两种取材方法均无漏诊。(3)取样器取材患者疼痛感显著小于刮匙组(P<0.001)。结论:Pipelle de Cornier子宫内膜取样器能够获取满意的标本用于组织学诊断,可用于大部分需常规诊断性刮宫的病例。     

Transvaginal ultrasound measurement of endometrial thickness and endometrial pipelle sampling as an alternative diagnostic procedure to hysteroscopy and dilatation and curettage in the management of post-menopausal bleeding.

In order to evaluate pipelle endometrial sampling combined with ultrasound measurement of endometrial thickness as an initial diagnostic procedure in the assessment of endometrial pathology in patients presenting with postmenopausal bleeding, 50 consecutive patients were studied prospectively. In each patient measurement of endometrial thickness and pipelle endometrial biopsy were performed as an out-patient procedure before hysteroscopy and dilatation and curettage (D&C). The diagnostic sensitivity with pipelle endometrial sampling alone in detecting endometrial pathology was 25% with a specificity of 100%. The measurement of endometrial thickness had a sensitivity of 62% with a specificity of 87.8%. Pipelle sampling combined with endometrial thickness increased the sensitivity to 87.5% with a specificity of 87.8%. Therefore, we suggest that pipelle sampling combined with sonographic measurement of endometrial thickness is an acceptable, less invasive alternative to hysteroscopy and D&C as a first-line investigation in the management of post-menopausal bleeding.     

Endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia

OBJECTIVE: Atypical endometrial hyperplasia (AEH) has been associated with the presence of concomitant endometrial carcinoma (EC). The aim of this study is to examine the frequency of coexisting endometrial carcinoma when atypical endometrium hyperplasia was found upon biopsy. We also evaluated the influence of preoperative diagnostic techniques (pipelle and dilation and curettage (D&C)), and the value of transvaginal ultrasound in detecting unexpected tumor invasion. STUDY DESIGN: Between January 1992 and December 2003, at the Department of Obstetrics and Gynecology, University of Parma, and Policlinico S. Matteo, Pavia, 70 consecutive patients subjected to total hysterectomy with a histological diagnosis of AEH were retrospectively selected. 52/70 patients underwent vaginal hysterectomy, with bilateral salpingo-oophorectomy (BSO) whereas 18/70 had abdominal hysterectomy with BSO within 8 weeks since the diagnosis of AEH. RESULTS: We found in 30 of the 70 patients with atypical endometrial hyperplasia in the biopsy coexisting endometrial carcinoma (43%). No differences in diagnostic accuracy between the pipelle method and D&C were found. CONCLUSION: Transvaginal ultrasound was not a feasible method for predicting EC. After a follow-up of an average of 5 years there was, neither in the abdominal operated patients nor in the vaginal operated patients, a recurrence of disease.     

Use of the endometrial pipelle in the diagnosis of early abnormal gestations

OBJECTIVE: To determine the sensitivity and specificity of the endometrial pipelle (Unimar, Wilton, CT) in detecting intrauterine chorionic villi, as compared to standard suction dilation and curettage (D and C). DESIGN: Prospective clinical study. SETTING: U. S. Navy Hospital near Tokyo, Japan. Small community hospital. PATIENT(S): All patients presenting for the surgical management of an early abnormal gestation were enrolled prospectively. The patient's age, gravidy, parity, estimated gestational age (EGA), diagnosis, preoperative beta human chorionic gonadotropin (betahCG) level, and preoperative transvaginal ultrasound (TVUS) data were recorded.Intervention(s): An endometrial biopsy was performed in the operating room prior to standard suction dilatation and curettage (D and C). MAIN OUTCOME MEASURE(S): The presence of chorionic villi in the endometrial biopsy and curettage specimens were recorded for each patient. RESULT(S): The sensitivity of the endometrial pipelle in detecting intrauterine chorionic villi was 63% and the specificity was 80%. CONCLUSION(S): In the diagnosis of an early abnormal gestation, particularly in excluding an ectopic pregnancy, it would be ideal to replace the more invasive D and C with the outpatient endometrial biopsy in detecting intrauterine chorionic villi. However, the limited sensitivity of the endometrial biopsy limits its application in this clinical scenario. Our results compare with two previous studies and add to the limited patient database on this topic.     

The Efficacy of the Pipelle Endometrial Biopsy in Detecting Endometrial Carcinoma

Summary: The purpose of this study was to determine the efficacy rate of the Pipelle endometrial biopsy sampler (Pipelle de Cornier) (1) in detecting endometrial carcinoma, and to analyze the tumour variables that may influence the success rate.
Thirty seven women with known endometrial carcinoma were tested preoperatively; there were 25 correct diagnoses (67%), the remaining 12 cases (33%) failed to demonstrate the correct diagnosis: 4 showed 'atypical epithelium', 2 showed 'atypical hyperplasia', 3 showed 'nonspecific epithelium' and the remaining 3 showed 'necrotic hyalinized material.
All cases were analyzed with respect to several tumour parameters, including the degree of differentiation, tumour volume, depth of invasion, and the extent to which the tumour filled the endometrial cavity. Poor results were obtained in well differentiated, low volume, and minimally invasive tumours, i.e. most early tumours, precluding its use as a screening tool.
A positive biopsy can save patients the time, cost, and inconvenience of a dilatation and curettage. However, in the light of these findings, a nonspecific finding should be interpreted with caution.     

Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C)

Purpose

To compare diagnostic accuracy and adequacy of pipelle endometrial biopsy with dilatation and curettage.

Methods

From October 2007 to November 2009, 673 patients were evaluated with pipelle endometrium biopsy, D&C and hysterectomy in the Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa Medical Faculty. 478 patients underwent pipelle and D&C, 212 patients underwent pipelle and hysterectomy and 161 patients underwent D&C and hysterectomy. Uterine findings were grouped under five headings: normal, hyperplasia, focal lesion, atypia, and atrophy. Histologic sections from pipelle biopsy or D&C specimens were compared with each other and hysterectomy specimens. Chi-square, Mc.Nemar, and Fisher-exact tests were used as appropriate. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each method used in the study.

Results

We compared the histological results of pipelle biopsy and D&C. Statistically outcomes of pipelle and D&C were concordant with each other. Concordance rate was 67?% between pipelle and hysterectomy and 70?% between D&C and hysterectomy. Sensitivity of pipelle biopsy in detection of hyperplasia and aytpia was 67 and 75?%, respectively. Sensitivity of D&C for detecting hyperplasia and atypia was 62 and 83?%. NPV of pipelle biopsy and D&C was 99?% for malignancy.

Conclusions

Pipelle biopsy and D&C showed almost equal success rate in the diagnosis of endometrial pathologies. Neither pipelle nor D&C is adequate method for focal endometrial pathologies. Both biopsy methods are not perfect, but pipelle biopsy is a cheaper and easy technique compared with D&C, and ultrasonographic findings of endometrium should be considered prior to endometrial biopsy.     

Endometrial adenocarcinoma--presenting pathology is a poor guide to surgical management

We aimed to evaluate the correlation between the histological grade of endometrial cancer diagnosed on endometrial biopsy or curettage, with the definitive grade and stage of lesion as determined by surgery and histopathological examination and to make recommendations about the suitability of conservative surgery based on pre-operative determination of the grade of endometrial adenocarcinoma. A retrospective review of all patients with endometrial adenocarcinoma presenting to the Queensland Centre for Gynaecological Cancer from 1 January 1996 to 31 December 1998 was undertaken. Clinical and pathological data was abstracted from medical records and case notes of 460 patients. All histological specimens were prospectively reviewed by a panel consisting of gynaecologic pathologists, gynaecologic oncologists and other doctors involved in the treatment of patients with gynaecological malignancies. The percentage of patients whose management would have been optimised by full surgical staging at the time of initial surgery was calculated. Only 60%, 71%, and 84 % of the patients with a presenting diagnosis of grade 1, 2 and 3 endometrial adenocarcinomas respectively had this confirmed on final histopathology. Furthermore, using established criteria, 30%, 46% and 100% of patients presenting with grade 1, 2 and 3 endometrial adenocarcinoma required full surgical staging at the time of their primary surgery There is poor correlation between the pre-operative grade of endometrial cancer and the grade as determined on analysis of the resected uterus. The correlation is poorest with grade 1 endometrial adenocarcinoma, where strongest consideration is given to conservative surgery and the avoidance of subspecialty referral. There is a strong argument that all patients with a diagnosis of endometrial cancer made on endometrial biopsy or curettage, regardless of grade of malignancy, should be offered surgery where the option to perform concurrent comprehensive surgical staging is available.     

Atypical hyperplasia of endometrium and hysteroscopy

OBJECTIVE: To evaluate the risk of discovering an endometrial cancer when atypical hyperplasia was diagnosed by either endometrial samples using the pipelle device or hysteroscopic resection products. PATIENTS AND METHODS: A retrospective monocentric study from january 1990 to july 2000. Twenty-three patients with atypical hyperplasia were included. Initial endometrial status was provided by endometrial biopsyduring diagnosis hysteroscopy (12 cases) or by operative hysteroscopic resection products (11 cases). For 23 patients, operative hysteroscopy and analyse of products resected were performed. For all patients, there was no hysteroscopical aspect evocative of adenocarcinoma. For 23 patients, histopathological analysis of the hysterectomy piece precised the final diagnosis. RESULTS: Among the 23 hysterectomy pieces, 7 adenocarcinomas were diagnosed (30.4%). Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by means of the pipelle biopsy device was 50% (6/12). Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by means of operative hysteroscopy resection products was 5.9 % (1/17). DISCUSSION AND CONCLUSION: Atypical endometrial hyperplasia evidenced by pipelle biopsy device is often associated with adenocarcinoma. Diagnosis hysteroscopy however does not show evident pathological aspect of adenocarcinoma in such cases. Operative hysteroscopy allows in most cases correction of endometrial status. Risk of omitting adenocarcinoma when atypical hyperplasia is discovered on hysteroscopic resection pieces is low.     

影响分段诊刮诊断子宫内膜癌细胞病理分级准确率的临床因素分析

目的:比较分段诊刮和术后子宫病理判断子宫内膜癌肿瘤病理分级的符合率,探讨影响分段诊刮诊断细胞级别准确率的临床因素。方法:回顾研究1993年1月至2008年1月上海交通大学医学院附属仁济医院妇产科收治的176例子宫内膜癌患者的临床资料,分析分段诊刮诊断子宫内膜癌病理分级的准确率及影响其准确率的临床因素。结果:以术后切除的子宫标本石蜡病理为标准,诊刮的病理分级总体准确率为35.2%(62/176)。50%(88/176)的患者分段诊刮细胞级别在石蜡病理结果中上升,仅14.8%(26/176)患者的肿瘤细胞分级下降。宫腔深度大于9cm,病理分级为G2或G3,浸润深度大于1/2肌层,p53阳性表达时诊刮的准确率较高。结论:分段诊刮诊断子宫内膜癌病理分级准确性较低,分化较差或进展晚期内膜癌患者的准确性较高。临床上对分段诊刮得出的肿瘤病理级别结果应谨慎。     

Microhysteroscopy in evaluation of the endocervix in endometrial carcinoma

Microhysteroscopy (MH) was used for the assessment of endocervical involvement in patients with endometrial carcinoma. Between 1 July 1984 and 28 February 1985, fifteen cases were seen. Of these, nine patients had had fractional curettage and all were deemed to have endocervical involvement. As a result of the use of MH, five of these stage II cases were down-staged. The remaining four cases had their staging confirmed by MH and directed endocervical curettage. The six patients who had no initial endocervical assessment were found to have Stage I disease, using the MH alone. The MH findings were corroborated and confirmed on histological examination of the surgical specimens. MH should be the initial investigation in patients with suspected endometrial carcinoma and all patients with postmenopausal bleeding.     

Actual aspects of endometrial carcinoma

The endometrial carcinoma is meanwhile the most common malignant tumor of the female genital tract. 2 subtypes can be divided according the pathogenesis: the classical estrogen related endometroid type and the nonclassical estrogen unrelated serous type. The endometrial adenomatous hyperplasia as a precancerous lesion must be identified by subjective criteria. Therefore the histological diagnosis is worse reproducible. An improvement would be helpful by morphometric and molecular genetic methods. The golden standard of diagnosis of the endometrial carcinoma is fractional dilatation and curettage. Immunohistochemical staining with a limited panel of antibodies can discriminate between an endometrial and an endocervical origin of an adenocarcinoma. The corner stone of the therapy is surgery. An individual decision about postoperative treatment is very important and depends on histological criteria. The adjuvant postoperative whole pelvic radiation is under discussion whereas the vaginal brachytherapy is established as standard therapy. This article outlines an overview of the actual situation for pathogenesis, diagnosis and treatment endometrial cancer.     

宫腔镜直视下活检及分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值

目的对照研究宫腔镜直视下活检及分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值。方法北京大学人民医院从2002年7月至2010年2月收治子宫内膜癌患者287例,分为宫腔镜直视下活检及分段诊刮(A)组90例,和单纯分段诊刮(B)组197例,比较两组术前病理诊断子宫内膜癌的准确性,判断宫颈受累的可靠性,比较两组腹腔冲洗液阳性率的差别及3年和5年总生存率的差异。结果 A组术前病理诊断的准确率为97.8%(88/90),B组为88.8%(175/197),差异有统计学意义(P<0.05)。A组宫颈受累估计的敏感度、准确率、阳性预测值、阴性预测值分别为77.8%,97.8%,100%和97.6%;B组分别为65.3%,85.8%,74.4%和89.0%。A组腹腔冲洗液阳性率为5.56%(5/90),B组为6.09%(12/197),差异无统计学意义(P>0.05)。A组3年总生存率为91.7%(33/36),5年总生存率为82.4%(14/17),B组分别为95.6%(87/91)和86.7%(39/45)。3年和5年总生存率间比较,差异均无统计学意义(P>0.05)。结论宫腔镜直视下活检及分段诊刮可提高术前子宫...     

Hysteroscopy with directed biopsy versus dilatation and curettage for the diagnosis of endometrial hyperplasia and cancer in perimenopausal women

BACKGROUND: The present study was undertaken to compare the effectiveness of dilatation and curretage (D&C) with hysteroscopy and guided biopsy (H+B) for the collection of endometrial samples adequate for histological examination in perimenopausal women at risk of endometrial hyperplasia or cancer. METHODS: We performed hysteroscopy and biopsy followed by dilatation and curettage in 734 patients with abnormal perimenopausal bleeding or sonographically revealed endometrial pathology. Two hundred and ninety-two patients in whom lesions were totally removed during hysteroscopy were excluded from further study. RESULTS: Using both methods we disclosed 64 cases of endometrial polyps, 60 cases of endometrial hyperplasia, and 49 cases of endometrial cancer. Hysteroscopy left just four cases of endometrial pathology undiagnosed as opposed to 21 cases using dilatation and curettage. Histology could not be performed on material obtained with hysteroscopy in four cases and with curettage in 23 cases. CONCLUSIONS: 1) Hysteroscopy with directed biopsy is more sensitive in disclosing all types of uterine lesions than dilatation and curettage. 2) Curettage done after hysteroscopy and directed biopsy does not improve the detection of endometrial cancer.     

Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia

AIM: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH). METHODS: Forty-six consecutive women who underwent hysterectomy for AEH were analyzed. RESULTS: Final histopathological evaluation of hysterectomy specimens revealed EC in 11 patients (23.9%). Preoperative diagnosis of AEH was established by pipelle biopsy in eight patients and curettage was performed in the remaining patients. Of the patients with pipelle biopsy, two had a diagnosis of EC (25%), whereas nine women who underwent curettage, were further diagnosed as having EC (23.7%) (P > 0.05). Four (13.3%) of 30 women who had frozen sections at hysterectomy, were diagnosed with EC. Diagnosis of EC was missed in two patients (50%) at frozen section. In contrast, seven of 16 women (43.7%) who did not have frozen section, had EC. CONCLUSION: A relatively high incidence of EC is seen in patients with a diagnosis of AEH. Diagnostic results of pipelle biopsy and curettage were comparable. Frozen sections of hysterectomy specimens does not guarantee to exclude the possibility of EC, especially in patients with no myometrial invasion.     

宫腔镜检查对Ⅱ型子宫内膜癌患者腹腔细胞学结果及预后的影响

目的:研究宫腔镜检查对Ⅱ型子宫内膜癌患者腹腔细胞学结果及预后的影响,探讨其用于Ⅱ型子宫内膜癌术前诊断的安全性。方法:回顾分析2001年6月至2010年6月在我院接受手术治疗且术后确诊为Ⅱ型子宫内膜癌的84例患者的临床病理资料。根据其术前诊断方式,分为宫腔镜检查组(32例)和传统诊刮组(52例)。比较两组患者的临床病理特点和腹腔细胞学检查阳性率,评价宫腔镜检查对Ⅱ型子宫内膜癌癌细胞腹腔播散的影响;分析术前不同诊断方式对Ⅱ型子宫内膜癌患者预后的影响。结果:两组患者的年龄、病理类型、临床分期、肌层浸润、累及附件及淋巴转移及治疗方式等比较,差异均无统计学意义(P0.05)。宫腔镜诊刮组与传统诊刮组的腹水细胞学检查阳性率分别为37.5%(12/32)和17.3%(9/52),差异有统计学意义(χ~2=4.308,P=0.036)。宫腔镜检查组与传统诊刮组患者的5年总生存率(OS)分别为56.8%和69.2%,5年无进展生存率(PFS)分别为50.7%和67.9%;两组患者的总生存率曲线和无进展生存曲线分别比较,差异均无统计学意义(P=0.329;P=0.424)。结论:宫腔镜检查用于Ⅱ型子宫内膜癌的诊断,可增加癌细胞腹腔播散的风险,但对其长期生存可能无影响。     

Uterine microcurettage with combined endometrial histopathology and cytology. An alternative to conventional curettage

A new disposable mechanical curette, the Inocurette, was used to obtain endometrial samples for histopathology and cytology. The instrument was tested on 120 patients; 37 patients were known from a previous conventional curettage (D & C) to have an endometrial cancer and 83 patients were referred to the County Hospital of Trelleborg for curettage because of dysfunctional bleedings. In all 120 patients a D & C followed the microcurettage procedure. The samples were randomized, coded and analyzed blind without any clinical information. In all but 3 patients with a known endometrial cancer, sufficient microcurettage sample material for either histopathology or cytology was obtained. In all but one of these 34 patients either a malignant diagnosis or seriously atypical cells were found. Using only cytology five out of 34 samples were designated adequate but normal. In a further 5 of the 37 patients the samples obtained at the subsequent D & C were inadequate for diagnosis; one sample was denoted as normal. In the 83 patients with dysfunctional bleedings, sufficient material for diagnosis after microcurettage, cytology and D & C was obtained in 74, 83 and 79 patients respectively. One endometrial cancer was disclosed by all three methods. Inocurette sampling causes little discomfort and requires no special training. The combined microcurettage--cytology procedure may be recommended as an alternative to conventional curettage, though, for the time being, D & C should not be replaced for cytology alone.     

The diagnosis of endometrial hyperplasia on curettage: how reliable is it?

Objective  To evaluate the consistency of preoperative and postoperative histological findings in cases of endometrial hyperplasia. Materials and methods  Fifty-five patients with endometrial hyperplasia detected by surgical curettage were treated by hysterectomy. The histopathological diagnoses found on curettage specimens were compared and correlated with those found on hysterectomy. Endometrial hyperplasia was classified according to the classification scheme of the International Society of Gynecological Pathologists. Results  Fifty-five patients were diagnosed with endometrial hyperplasia on curettage specimens performed for evaluation of various bleeding abnormalities. The average age of the patients was 51.8 years (range 35–74). Thirty patients (55%) were postmenopausal. The interval between curettage and hysterectomy was 1–33 weeks. Of the patients, 26 (47%) had simple hyperplasia, 24 (44%) complex hyperplasia and 5 patients (9%) had complex atypical hyperplasia. Histopathological evaluation of hysterectomy specimens of these patients showed a total number of 35 cases (64%) with endometrial hyperplasia, 1 case of endometrial carcinoma and 19 cases with other pathological findings. The consistency rate between curettage and hysterectomy specimens was 45% (25/55 cases). Following hysterectomy, we found that none of the 26 simple hyperplasia cases and only one of the 24 complex hyperplasia cases coexisted with endometrial carcinoma. On the other hand, three of the five cases of complex atypical carcinoma coexisted with endometrial carcinoma. Conclusions  Curettage endometrial pathology tends to be more consistent with final hysterectomy pathology in simple hyperplasia. However, in cases of complex hyperplasia with atypia, curettage seems to under diagnose the real pathology.     

宫腔镜检查诊断子宫内膜癌的价值及与腹腔冲洗液阳性的关系探讨

目的:探讨宫腔镜检查对子宫内膜癌的诊断价值,以及是否增加腹腔冲洗液细胞学阳性率。方法:回顾性分析在本院行手术治疗后病理检查确诊为子宫内膜癌患者113例的临床资料,其中术前行单纯分段诊断性刮宫71例(分段诊刮组),行宫腔镜检查后再行分段诊刮42例(宫腔镜组)。比较两组手术前后的诊断、组织学分级、组织学类型符合率,腹腔冲洗液细胞学的阳性率,并同时分析组织学类型、组织学分级、肌层浸润深度、病灶分布、附件转移等与腹腔冲洗液细胞学的关系。结果:宫腔镜组42例患者,病理诊断符合率97.62%(41/42),高于分段诊刮组的病理诊断符合率83.10%(59/71),差异有统计学意义(P<0.05)。宫腔镜组腹腔冲洗液阳性率28.57%(12/42),高于分段诊刮组的阳性率25.35%(18/71),但两组比较差异无统计学意义(P>0.05)。113例子宫内膜癌患者腹腔冲洗液阳性与宫腔病灶范围大小有关(P<0.05),与附件转移、子宫肌层浸润深度、组织学类型、组织学分级无关(P>0.05)。结论:宫腔镜检查诊断子宫内膜癌准确性优于单纯分段诊刮,并且不增加腹腔冲洗液阳性率。腹腔冲洗液阳性率与宫腔病灶范围大小有关。     

The value of curettage in diagnosis of endometrial hyperplasia.

OBJECTIVES: The aim of this study was to assess the value of diagnosis of endometrial hyperplasia by curettage and to determine the results of proliferating cell nuclear antigen (PCNA) immunostaining in differentiating endometrial carcinoma from endometrial hyperplasia. METHODS: According to Kurman's criteria, we treated 150 patients with endometrial hyperplasia detected by curettage and compared retrospectively the diagnosis by curettage with that by hysterectomy. PCNA expression was examined using immunohistochemostaining on 60 patients with complex atypical hyperplasia detected by curettage. RESULTS: Simple hyperplasia was found by curettage in 53 patients, complex hyperplasia in 11, simple atypical hyperplasia in 26, and complex atypical hyperplasia in 60. All patients were rediagnosed after hysterectomy. As a result, 65 were found to have simple hyperplasia, 7 complex hyperplasia, 15 simple atypical hyperplasia, 29 complex atypical hyperplasia, and 34 endometrial carcinoma. The accuracy of histological diagnosis by curettage was 76.7-92.0% and was dependent on different types of hyperplasia. Simple atypical hyperplasia and complex atypical hyperplasia were more likely to coexist with endometrial carcinoma than both simple hyperplasia and complex hyperplasia (chi2 = 26.3, P < 0.001), and complex atypical hyperplasia was more likely to coexist with endometrial carcinoma than simple atypical hyperplasia (chi2 = 9.78, P < 0.005). In complex atypical hyperplasia patients, coexistence with endometrial carcinoma was more common after menopause than before menopause (chi2 = 3.93, P < 0.05). In complex atypical hyperplasia patients, the expression of PCNA in cases associated with endometrial carcinoma was higher or stronger than in cases associated without endometrial carcinoma (chi2 = 7.68, P < 0.01, or U = 252.00, P < 0.01). Conclusions. Curettage tends to be more highly accurate in diagnosing simple hyperplasia than complex atypical hyperplasia, which is often found by hysterectomy to be associated with endometrial carcinoma. The expression of PCNA may be helpful in differentiating complex atypical hyperplasia from endometrial carcinoma.