子宫内膜癌术前诊断性刮宫与术后病理诊断差异的研究

目的 探讨子宫内膜癌术前诊断性刮宫与术后病理诊断的差异,为提高术前子宫内膜癌诊断的准确率提供指导.方法 回顾性分析124例经病理检查确诊为子宫内膜癌患者的病历资料,包括临床分期、病理分期、病理类型、组织学分级等.结果 124例子宫内膜癌患者中,术前诊断性刮宫结果为子宫内膜癌102例,诊断符合率为82.3％（102/124）;误诊22例,误诊率为17.7％（22/124）.102例术前和术后诊断相符患者的术前临床分期与术后病理分期总符合率为81.4％（83/102）,其中Ⅰ期符合率为86.1％（62/72）,Ⅱ期符合率为72.0％（18/25）,Ⅲ期符合率为3/5;术前诊断性刮宫组织学分级与术后病理组织学分级总符合率为65.7％ （67/102）,G1级符合率为55.6％（25/45）,G2级符合率为69.2％（27/39）,G3级符合率为15/18.结论 子宫内膜癌术前诊断性刮宫和术后病理诊断的病理类型、病理分期以及组织学分级均存在不一致的情况,因此临床中需要结合多种检查手段,全面评估,以减少手术前后的诊断差异,提高术前诊断的准确率.

Clinical study of diagnostic difference between preoperative diagnostic curettage and postoperative pathological diagnosis in endometrial carcinoma

Objective To investigate the diagnostic difference between preoperative diagnostic curettage and postoperative pathological diagnosis in endometrial carcinoma,and provide guidance for the accuracy in preoperative diagnosis of endometrial carcinoma.Methods The data of 124 endometrial carcinoma patients were retrospectively analyzed,including clinical stage,pathological stage,pathological type,histologic grade,etc.Results In 124 endometrial carcinoma patients,102 cases of endometrial carcinoma were found by preoperative diagnostic curettage,the diagnostic accordance rate was 82.3% （102/124）,misdiagnosis was in 22 cases,the misdiagnosis rate was 17.7%（22/124）.The total accordance rate of preoperative clinical stage and postoperative pathological stage was 81.4% （83/102） in 102 patients who had the same preoperative and postoperative diagnosis,and the accordance rate of Ⅰ stage was 86.1% （62/72）,the accordance rate of Ⅱ stage was 72.0%（18/25）,the accordance rate of Ⅲ stage was 3/5.The total accordance rate of preoperative diagnostic curettage histologic grade and postoperative pathological histologic grade was 65.7%（67/102）,and the accordance rate of G1 grade was 55.6% （25/45）,the accordance rate of G2 grade was 69.2% （27/39）,the accordance rate of G3 grade was 15/18.Conclusions The pathological type,pathological stage and histologic grade of preoperative diagnostic curettage and postoperative pathological diagnosis in endometrial carcinoma are not always consistent.A variety of diagnostic methods should be considered together in order to reduce the diagnosis difference preoperative and postoperative,and improve the accordance rate of preoperative diagnosis.