子宫内膜癌高危型患者术前、术中病情评估准确性探讨

目的分析术后病理确诊的高危型子宫内膜癌患者术前和术中诊断的准确性。方法回顾性分析北京大学第三医院1994年～2006年间高危型子宫内膜样癌患者的临床资料，比较术前诊刮结果、术中医生肉眼对肌层浸润的判断与最终病理结果间的异同，分析高危患者术中术前漏诊和误诊的比率，以及诊断的准确率。结果201例子宫内膜癌患者中52例（25．9％）为高危型。其中39例患者为高危组织学类型，术前刮宫诊断符合率为56．4％（22／39）。23例患者存在深肌层浸润，术中肉眼对深肌层浸润判断的准确率为47．8％（11／23）。201例患者中35例术前判断宫颈受累，其中只有10例（28．6％）在术后病理中得到证实。52例患者中术前术中诊断为中低危型的比率为30．8％（16／52）。201例研究对象中对高危患者诊断的敏感性和特异性分别为69．2％（36／52）与89．9％（134／149）。结论高危型子宫内膜样癌患者其如何提高术前及术中病情评估准确性有待探讨。术前诊刮和术中的诊断与其最终的病理检查间存在较高的不一致性。

Analysis on pre-operative and intra-operative diagnosis accuracy of the patients with high-risk endometrial carcinoma

Objective To analyze the pre - operative and intra - operative diagnosis accuracy of the patients with high- risk endometrial carcinoma. Methods We retrospectively compared the pathology of preoperative D＆C and intra - operative evaluation of myometrial invasion to the final pathology diagnosis of the patients with high - risk endometrial carcinoma who underwent treatment in Peking University Third Hospital from 1994 to 2006. Results A total of 201 patients with endometrial cancer were enrolled in the study, of whom 52 patients were with high risk features. In comparison of pre - and postoperative histology, only 56.4% of them were diagnosed accurately by D＆C. The accuracy rate of intra -operative assessment for depth of deep myometrial invasion was 47. 8% （11/23）. Thirty - five patients were estimated with cervical invasion by pre -operative D＆C, of whom only 10 （28.6%） were with cervical lesion in the operative pathology. Of the 52 patients, 16 （30. 8%） were under- estimated to be with low - or moderate - risk features during surgery. The sensitivity and specificity of pre - or intra - operative diagnosis of high risks endometrial carcinoma were 69.2%（36/52） and 89.9%（134/149） respectively. Conclusion For endometrial carcinoma with high- risk features, the consistence of pre- or intra- operative diagnosis with the postoperative pathology results was poor.