子宫内膜癌围手术期评估与术后病理的对比研究

目的通过对1229例子宫内膜癌病例进行回顾性分析，比较手术前后评估结果与术后病理结果符合率，为临床围手术期评估提供依据。方法收集2000-2012年浙江大学附属妇产科医院收治的经病理确诊，且资料完整的1229例子宫内膜癌病例，以手术切除的子宫标本病理诊断为“金标准”，与围手术期评估结果进行比较。结果子宫内膜腺癌术前术后符合率为75．59％，Kappa值为0．21（95％CI：0．15～0．27）。非子宫内膜样腺癌术前与术后符合率为89．99％，Kappa值为0．41（95％CI：0．32～0．49）。腺鳞癌术前术后诊断符合率为97．40％，Kappa值为0．10（95％CI：-0．04～0．24）。术前组织病理学分级与术后病理分级符合率为69．57％，加权Kappa值为0．50（95％CI：0．46～0．55）。B超提示宫颈受累与术后病理提示宫颈受累符合率为43．62％，Kappa（95％CI）为-0．01（～0．04～0．03）。CT提示宫颈受累与术后病理提示宫颈受累符合率为65．32％，Kappa（95％CI）为0．26（0．20～0．32）。淋巴结阳性率随手术病理分期的升高而增高（P〈0．01）。结论子宫内膜癌的部分高危因素术前难以准确判断，对于子宫内膜癌患者，应行全面分期手术，以改善预后。

A comparison study on perioperative evaluation and postoperative pathological results among patients with endometrial carcinoma

Objective To evaluate the accuracy of perioperative evaluation of endometrial cancer by comparing with postoperative pathological results among patients. Methods we retrospectively analyzed the clinical data of 1 229 cases of endometrial cancer, and all patients received surgery in Obstetrics and Gynecology Hospital of Zhejiang University from 2000 to 2012. The information of all cases were analyzed and compared with the postoperative pathological results, which is thought to be gold standard. Results Between the results of preoperative and postoperative, the coincidence rate of endometrial adenocarcinoma was 75.59% , while non - endometrial adenoearcinoma was 89. 99% , the Kappa values were 0.21（95% CI： 0. 15 - 0.27） and 0.41 （95% CI： 0.32 - 0.49） respectively. Besides, the coincidence rate of adenosquamous carcinoma was 97. 40% and the Kappa value is 0. 10 （95% CI： -0. 04 -0. 24 ）. The coincidence rate of preoperative histopathological grading and postoperative pathological classification was 69. 57%, and the weighted Kappa value was O. 50 （95% CI： 0. 46 -0. 55 ）. The coincidence rate between ultrasonic examination and pathological results was 43.62% , and the Kappa value was 0. 01 （95% CI： -0. 04 -0. 03 ）. The coincidence rate between CT and pathological results was 65.32% , and the Kappa value was 0. 26 （95% CI：0. 20 -0. 32 ）. Lymph node positive rate were increased with operation pathologic staging （ P 〈 0. 01 ）. Conclusion perioperative evaluation is not sufficient for risk assessment of endometrial carcinoma, and comprehensive staging surgery should be conducted on all patients with endometrial carcinoma.