子宫内膜癌术中冰冻病理的指导价值

目的:探讨子宫内膜癌术中快速冰冻病理的指导价值。方法:回顾分析2013年1月1日至2015年1月1日在青岛大学附属医院行手术治疗且术后病理证实为子宫内膜癌的203例患者的临床资料。研究术中冰冻与石蜡病理在诊断肿瘤分化级别、肌层浸润深度、组织分型的符合率,以评估其在子宫内膜癌分期手术中的临床价值。结果:术中冰冻与石蜡病理的组织学分化级别、肌层浸润深度和组织分型的符合率分别为82.8%、90.1%和93.5%,仅有1例患者因冰冻与石蜡病理不符合导致手术治疗不足。结论:子宫内膜癌术中冰冻病理与术后石蜡病理在子宫内膜癌分化级别、肌层浸润深度、组织分型方面具有较高的符合率。以术中冰冻病理来决定子宫内膜癌患者是否行分期手术具有一定的临床意义。     

子宫内膜癌术中冰冻和术后石蜡病理诊断符合率及其影响因素

目的：研究影响子宫内膜癌患者术中冰冻病理与术后石蜡病理诊断符合率的临床因素。方法：回顾分析1996年7月—2008年1月在上海交通大学医学院附属仁济医院和2008年9月—2011年9月在同济大学附属第一妇婴保健院收治的共389例子宫内膜癌患者的临床治疗资料。观察术中冰冻病理与术后病理在诊断肿瘤细胞级别、肿瘤肌层浸润深度方面的符合率及影响符合率的因素。结果：①术中冰冻与术后石蜡病理的细胞级别的总体符合率为78.6%（147/187）,其中G1,G2和G3的符合率分别为88.6%,60.6%和95.2%。随着石蜡病理诊断细胞级别的升高和肌层浸润深度的加深,细胞级别诊断符合率逐渐升高（P=0.008,P=0.002）。②肌层浸润深度的总体符合率为97.8%（178/182）。石蜡病理诊断细胞级别提高,肌层浸润的符合率逐步下降（P=0.027）。结论：冰冻病理在诊断子宫内膜癌肌层浸润深度上符合率较高,在细胞级别的诊断上有一定局限。     

分段诊刮诊断子宫内膜癌临床价值分析

目的 评价分段诊刮诊断子宫内膜癌的临床价值.方法 回顾分析2000年1月至2002年11月在上海交通大学医学院附属仁济医院收治的52例子宫内膜癌患者,比较分析患者术前的分段诊刮和术后子宫病理,判断肿瘤细胞分级的符合率.结果 以术后子宫病理为标准,所有患者均为子宫内膜腺癌,分段诊刮和术后子宫病理在G1子宫内膜癌符合率为20%,G2肿瘤符合率为61.5%,G3内膜癌符合率为77.8%.G2和G3肿瘤病理诊断符合率同G1肿瘤相比较,差异均有统计学意义(G2对G1,x2=6.6,P=0.010;G3对G1,x2=7.726,P=0.005).14例患者分段诊刮病理提示为"子宫内膜非典型增生",而术后子宫病理均诊断为"子宫内膜腺癌".分段诊刮诊断细胞分级的准确率仅有50%(26/52),根据术后病理报告,48%(24/50)左右的患者肿瘤分级升级.当内膜癌浸润≥1/2子宫肌层深度时,病理诊断苻合率(75.0%)显著高于侵入内膜层者(22.2%),差异有统计学意义(x2=4.735,P=0.030).结论 分段诊刮和术后子宫病理在G3>和≥1/2子宫肌层浸润子宫内膜癌患者保持较高的符合率.与术后病理比较,分段诊刮诊断子宫内膜癌肿瘤细胞组织学级别被降低.临床上应重视分段诊刮的内膜癌病理报告.     

影响子宫内膜癌术中冰冻诊断准确性的临床因素分析

目的 探讨术中冰冻诊断子宫内膜癌的临床价值及影响准确率的临床因素.方法 回顾性研究1993年1月至2008年1月上海交通大学医学院附属仁济医院收治的84例子宫内膜癌患者的临床资料,计算诊断肿瘤细胞级别和肌层侵袭深度的准确率,分析影响准确率的临床因素,并进行随访患者生存分析.结果 以术后子宫病理为标准,术中冰冻与术后病理的细胞级别的总体符合率为68.9%(51/74).其中G1、G2、G3子宫内膜癌符合率分别为57.1%、68.4%、86.7%.通过术后病理比较证实,冰冻所得结果中10.8%(8/74)肿瘤级别上升,仅有4.1%(3/74)级别下降.74例肌层侵袭深度的整体符合率为86.5%(64/74).在浸润深度≥1/2肌层侵袭的病例中,符合率为93.3%(14/15),显著高于<1/2肌层的符合率84.7%(50/59),差异有统计学意义(P<0.01).相符组与不相符组比较,绝经后子宫出血患者(P=0.004)、B超提示宫腔内结节的血流阻力指数<0.5(P=0.005),是术中冰冻诊断细胞级别准确性提高的临床因素.结论 术中冰冻诊断细胞级别和侵袭深度不能完全符合术后病理结果,肿瘤细胞分化越差(G3),肌层侵袭越深(≥1/2),术中冰冻与术后子宫病理诊断符合率就越高.两者诊断技术的符合率并未显著影响患者的生存率.     

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。     

经阴道彩色多普勒超声对子宫内膜癌肌层浸润程度的探讨

目的:探讨术前经阴道彩色多普勒超声(TVCDS)判断子宫内膜癌肌层浸润程度的准确性及临床应用价值。方法:对51例术前行TVCDS检查、经手术病理证实为临床Ⅰ期的子宫内膜癌患者进行分析,根据二维图像特点和病灶内部及周围肌层的彩色血流情况,判断其肌层浸润程度,并与术后病理结果进行对照分析。结果: 51例患者术前超声均能正确诊断,超声判断子宫内膜癌肌层浸润总符合率为72 55% (37 /51),浅肌层浸润符合率为69 .23% (18 /26),深肌层浸润的符合率为82. 35% (14 /17 )。结论:TVCDS能较准确地协助诊断子宫内膜癌并判断肌层浸润深度,为术前判断肌层浸润程度提供了有效途径。     

术中快速冰冻病理检查诊断子宫内膜癌的价值

子宫内膜癌是女性生殖系统发生率很高的恶性肿瘤之一.快速冰冻病理是术中唯一诊断子宫内膜癌病理类型、病理分级及肌层侵袭深度、淋巴结转移情况的病理检查手段.结果可帮助在术中判断是否有必要实施详细的手术病理分期.众多研究表明,多种因素会影响快速冰冻病理检查的准确性,导致部分患者过度治疗或治疗不足.增加患者术后病率并影响其远期生存.综述术中冰冻切片在子宫内膜癌诊断中的准确性及影响因素.     

术中快速冰冻病理检查诊断子宫内膜癌的价值

子宫内膜癌是女性生殖系统发生率很高的恶性肿瘤之一。快速冰冻病理是术中唯一诊断子宫内膜癌病理类型、病理分级及肌层侵袭深度、淋巴结转移情况的病理检查手段。结果可帮助在术中判断是否有必要实施详细的手术病理分期。众多研究表明,多种因素会影响快速冰冻病理检查的准确性．导致部分患者过度治疗或治疗不足,增加患者术后病率并影响其远期生存。综述术中冰冻切片在子宫内膜癌诊断中的准确性及影响因素。     

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。     

探析术中快速冰冻病理检查对子宫内膜癌的诊断意义

目的探讨子宫内膜癌患者选择术中快速冰冻病理检查的临床诊断价值。方法选择我院2012年10月~2015年7月收治的子宫内膜癌患者108例为研究对象。针对患者实施术中快速冰冻病理检查,之后对患者实施术后病理切片检查,并且将术后病理切片检查作为标准,针对临床诊断正确率以及病理分期特点进行分析。结果对患者实施术中快速冰冻病理检查的临床正确率为66.7%,在分期方面,G1期、G2期同G3期准确率表现对比,差异有统计学意义(P0.05);在分级方面,Ⅰ级、Ⅱ级以及Ⅲ级之间对比,差异有统计学意义(P0.05)。结论针对子宫内膜癌患者,临床选择术中快速冰冻病理检查的方法进行诊断,表现出较高的准确率,并且伴随着患者疾病分期的不断提高,临床诊断准确率显著提高,从而对疾病的临床诊断发挥显著的应用价值。     

HIF1α、Glut1在子宫内膜癌中的表达及其临床意义

目的:探讨HIF1α、G lut1在子宫内膜癌中的表达及其临床意义,并分析两者的相关性。方法:用免疫组化S-P法检测15例正常子宫内膜、17例不典型增生子宫内膜、45例子宫内膜癌组织中HIF1α、G lut1的表达。结果:HIF1α、G lut1在子宫内膜癌和不典型增生子宫内膜中的阳性率明显高于正常子宫内膜,差异有统计学意义(P<0.05)。在子宫内膜癌组织中HIF1α蛋白阳性表达率与组织病理学分级、手术病理分期无关(P>0.05),但与肌层浸润深度和淋巴结转移有关,差异有统计学意义(P<0.05);G lut1随病理组织学分级的增加、手术病理分期的进展、肌层浸润深度的加深和淋巴结转移,其阳性率逐渐上升,差异有统计学意义(P<0.05);HIF1α蛋白、G lut1蛋白表达呈正相关(r=0.741,P=0.000)。结论:HIF1α、G lut1蛋白的异常表达与子宫内膜癌的发生、发展有一定的关系。     

A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer

OBJECTIVE: To prospectively evaluate in a blinded fashion the accuracy of frozen section in endometrial cancer. METHODS: Sixty patients with endometrial cancer or complex atypical hyperplasia were consecutively enrolled. Intraoperatively, a frozen section was obtained, processed, and stored for interpretation by blinded pathologists. Final pathologic diagnosis was conducted in the usual fashion with the pathologists blinded to frozen results. Histologic grade and myometrial invasion on frozen section was correlated with final pathology. RESULTS: Median age was 61 years (range, 39-82 years). Fifty-seven percent of patients were white, and mean body mass index was 40 mg/kg2. Depth of invasion on frozen correlated with final pathology in 67% (95% confidence interval [CI] 55-79%). Twenty-eight percent (95% CI 17-39%) of patients were upstaged from frozen to final. Patients with no invasion on frozen were upstaged in 46% (95% CI 28-64%). Histologic grade on frozen correlated with final pathology in 58% (95% CI 46-70%); 38% (95% CI 26-50%) of patients were upgraded by final grade. Patients with frozen grade 1 histology or less were upgraded in 61% (95% CI 45-77%). Clinically relevant upstaging occurred in 11 patients (18%) (95% CI 8-28%). CONCLUSION: Frozen section for histologic grade and depth of myometrial invasion in endometrial cancer correlates poorly with final pathology. Because a large number of patients are potentially understaged with the use of frozen section with a subsequent risk of over and under treatment, we recommend consideration of comprehensive surgical staging for all patients with endometrial cancer. LEVEL OF EVIDENCE: II-2.     

冰冻病理诊断预测子宫内膜癌淋巴转移的临床价值研究

目的:研究影响子宫内膜癌患者淋巴结转移的因素,评价术中冰冻病理预测淋巴结转移的作用。方法:回顾分析1996年7月至2008年1月在上海交通大学医学院附属仁济医院和2008年9月至2011年9月在同济大学附属第一妇婴保健院收治的共389例子宫内膜癌患者的临床资料,195例患者实施了盆腔淋巴结切除,其中43例同时行腹主动脉旁淋巴结切除。分析患者淋巴结转移的临床相关因素,评价冰冻病理结果在预测淋巴结转移中的价值。结果:盆腔淋巴结转移率为12.8%(25/195),腹主动脉旁淋巴结转移率为11.6%(5/43)。深肌层浸润(P<0.001)、宫颈累及(P<0.001)、ER阴性(P=0.001)与盆腔淋巴结转移显著相关。肿瘤细胞级别升高、病理类型(Ⅰ型、Ⅱ型)与盆腔淋巴结转移无显著相关性。低风险子宫内膜癌(排除G3和肌层深度≥1/2)患者的盆腔淋巴转移率为4.5%(3/67)。按冰冻结果制定4种预测模型,G1+限于内膜组,淋巴结阳性率为0;G1+<1/2肌层组,盆腔和腹主淋巴结阳性率均为2.4%;G2+<1/2肌层组,盆腔和腹主淋巴结阳性率分别为4.8%、0;未发现G2+限于内膜的病例。淋巴结切除组的生存率高于未切除组(79.5%vs 75.9%),但无统计学差异(P=0.086)。结论:冰冻病理用于预测淋巴结转移的作用有限,建议对除G1限于内膜的子宫内膜样腺癌患者,其余均应实施全面的分期手术。     

20例早发型子宫内膜癌的临床特点分析

目的：探讨40岁以下子宫内膜癌患者的临床及病理特征。方法：对2004年12月—2012年12月收治的子宫内膜癌病例进行回顾性分析,其中≤40岁的患者（早发组）20例（占4%,20/498）,＞40岁的患者（普通组）478例,比较2组患者的多项临床指标,分析患者的临床特征、高危因素、治疗方法、病理类型、组织学分级、肌层浸润深度、淋巴结转移与附件转移的关系。结果：早发组原发不孕发病率为30.0%（6/20）,普通组为4.2%（20/478）,差异有统计学意义（χ2=25.855,P=0.000）。普通组合并高血压率高于早发组（χ2=7.954,P=0.003）。早发组患者病理类型均为子宫内膜样腺癌,普通组子宫内膜样腺癌78.5%（375/478）,2组患者病理类型差异有统计学意义（χ2=5.433,P=0.020）。早发组、普通组患者细胞分化为G1者分别占90%和49.8%。早发组、普通组临床病理Ⅰ期者分别占80%和74.1%,2组患者细胞分化程度及临床病理分期差异有统计学意义（Z分别为－8.259和－9.488,均P=0.000）。2组患者肌层浸润、宫颈累及、淋巴结转移、附件累及和腹水细胞学检查比较差异均无统计学意义（均P＞0.05）。结论：在子宫内膜癌患者中年轻妇女有着一定的比例,不孕不育是40岁以下子宫内膜癌患者的高危因素,年轻子宫内膜癌患者以子宫内膜样腺癌为主,细胞分化级别高,手术病理期别较早,深肌层浸润、淋巴结转移以及附件转移等情况与年长者相似。     

Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma. METHODS: Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist. RESULTS: The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%). CONCLUSION: If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.     

Cost-effectiveness analysis of strategies for the surgical management of grade 1 endometrial adenocarcinoma

OBJECTIVE: To estimate the costs and outcomes of various strategies used for the management of grade 1 endometrial cancer. METHODS: A cost-effectiveness analysis compared three strategies for the management of grade 1 endometrial cancer: 1) surgical staging in all patients (including hysterectomy and lymphadenectomy); 2) frozen section following hysterectomy with surgical staging based on the results of tumor grade and depth of myometrial invasion; and 3) hysterectomy without surgical staging (no staging). Surgical probabilities and recurrence rates were estimated from published data. Actual payer costs of surgery, radiation therapy, and chemotherapy were estimated for each strategy. Cost-effectiveness ratios were estimated for each strategy. Sensitivity analyses evaluated the costs of radiation and survival estimates used in the model. RESULTS: For the estimated 10,000 women diagnosed annually with grade 1 endometrial cancer in the United States, the annual cost of surgical staging is $240.4 million, compared with $252.4 million for frozen section and $255.8 million for no staging. Five-year disease-free survival for surgical staging is 87.9%, compared with 87.3% for frozen section and 86.7% for no staging. This translates into a lower cost-effectiveness ratio for surgical staging ($27,337) compared with frozen section ($28,913) or no staging ($29,513). Surgical staging yielded 64 additional disease-free patients per 10,000 patients compared with frozen section and 126 additional disease-free patients compared with no staging. Use of adjuvant radiation therapy was the lowest in the surgical staging strategy (13%). CONCLUSION: Surgical staging of all patients with grade 1 endometrial cancer is the most cost-effective strategy and decreases the use of radiation therapy without negatively impacting survival.     

Accuracy of frozen-section diagnosis at surgery in clinical stage I and II endometrial carcinoma.

OBJECTIVES: The purpose of our study was to determine if frozen section accurately identifies certain poor prognostic pathologic factors in endometrial carcinoma that are known to be associated with pelvic and paraaortic nodal metastasis, including deep myometrial invasion, poorly differentiated tumor, cervical invasion, adnexal involvement, and poor histologic type. STUDY DESIGN: The frozen-section pathologic results of 199 patients with clinical stage I and II endometrial cancer were retrospectively compared with permanent-section pathologic findings. RESULTS: The depth of myometrial invasion (superficial third vs deep two thirds) was accurately determined by frozen-section diagnosis at surgery in 181 of 199 cases (91.0%). The sensitivity of frozen-section diagnosis for deep myometrial invasion was 82.7%, and the specificity was 89.1%. The following tumor characteristics were accurately determined on frozen section at surgery: poorly differentiated tumor (95.0%), cervical invasion (94.0%), adnexal involvement (98.5%), and histologic type (94.0%). Frozen section underestimated deep myometrial invasion in 17.3% of patients with this characteristic and poorly differentiated tumor in 26.3% when compared with permanent-section diagnosis. In patients with unfavorable histologic types, papillary serous and adenosquamous carcinomas were the most commonly misdiagnosed histologic types by frozen section at surgery (70.6%). However, when the preoperative curettage pathologic findings were included, these inaccuracies in tumor grade and histologic type dropped to 15.8% and 35.3%, respectively. Only 13 of 199 patients (6.5%) were not correctly identified by frozen section at surgery as having poor prognostic pathologic features. CONCLUSION: Frozen section diagnosis at surgery is an important procedure that enables the surgeon to identify patients at high risk for pelvic and paraaortic nodal metastasis.     

Assessment of depth of myometrial invasion in endometrial adenocarcinoma

Depth of myometrial invasion in stage I adenocarcinoma of the endometrium is recognized as a prognostic factor for lymph node metastasis and overall survival. To determine if depth of myometrial invasion estimated by gross examination correlated with final histologic depth of invasion, we retrospectively reviewed all cases of surgical stage I endometrial adenocarcinoma treated at our institution between July 1985 and July 1988. Of the 113 evaluable patients, 63 had grade 1 lesions, 37 grade 2 lesions, and 13 grade 3 lesions. The depth of invasion was accurately determined by gross examination in 55 of 63 (87.3%) grade 1 lesions, 24 of 37 (64.9%) grade 2 lesions, and only 4 of 13 (30.8%) grade 3 lesions. Thus, gross examination of fresh tissue to estimate depth of myometrial invasion in endometrial adenocarcinoma is less reliable as the grade of the tumor increases. Alternative methods, such as frozen section, should be considered when evaluating depth of invasion, especially when this affects intraoperative decisions regarding lymph node sampling.