绝经后妇女子宫内膜癌筛查方法445例分析

目的 探讨绝经后妇女中进行子宫内膜癌筛查的适宜方法和策略。方法 2010年7月至2011年3月在北京大学第一医院、北京肿瘤医院和北京大兴区人民医院接受子宫内膜液基细胞学检查的绝经后妇女共445例，以分段诊刮、组织病理学为标准，评价子宫内膜细胞学（endometrial cytological test, ECT）与经阴道超声（transvaginal ultrasound, TVS）诊断子宫内膜癌或癌前病变的准确性。结果 子宫内膜细胞学取材满意度高于诊刮 （χ2=3.722, P<0.001)。单独ECT阳性、单独TVS阳性、ECT和TVS阳性、ECT或TVS阳性诊断子宫内膜癌或癌前病变的敏感度分别为85.7%, 83.9%, 67.8%, 96.4%, 特异度分别为 84.5%, 20.6%, 88.6%, 21.7%, 阳性预测值分别为 64.0%, 25.3%, 65.5%, 28.2%, 阴性预测值分别为 94.8%, 80.0%, 89.6%, 95.0%, 诊断准确性分别为 84.8%, 35.9%, 83.5%, 39.8%。结论 ECT联合TVS是绝经后妇女进行子宫内膜癌筛查的适宜方法。

Analysis of endometrial carcinoma screening method in 445 postmenopausal women.

Abstract： Objective To investigate the appropriate methods and strategies of endometrial cancer screening in postmenopausal women. Methods A total of 445 cases of postmenopausal women were enrolled in the study, who accepted liquid-based endometrial cytology in three hospitals in Peking from July 2010 to March 2011.We evaluated the accuracy of liquid-based endometrial cytology and transvaginal ultrasound as compared to dilatation and curettage.Results In our population, the cytology provided sufficient material more often than biopsy （χ2=3.722, P<0.001). Sensitivity of cytology, TVS, cytology and TVS positive, cytology or TVS positive,in diagnosing adenocarcinoma or atypical hyperplasia were estimated at 85.7%, 83.9%, 67.8% and 96.4%, specificity at 84.5%, 20.6%, 88.6% and 21.7%, positive predictive value at 64.0%, 25.3%, 65.5% and 28.2%, negative predictive value at 94.8%, 80.0%, 89.6% and 95.0%, and accuracy at 84.8%, 35.9%, 83.5% and 39.8%, respectively.Conclusion Endometrial cytology combined with transvaginal ultrasound may be the appropriate method to screen endometrial cancer in postmenopausal women.