子宫内膜细胞学检查在子宫内膜病变中的临床意义
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摘要
目的探讨子宫内膜细胞学检查(ECT)诊断子宫内膜病变的临床价值。方法收集2017年6月—2018年6月于本院就诊的171例疑有内膜病变、拟行诊刮手术患者的一般临床资料,先采用SAP-1子宫内膜采集器获取细胞学标本,后行诊断性刮宫术获取组织学标本。比较两种方法采集的标本满意度情况,是否绝经及子宫内膜厚度对两种方法获得标本满意度的影响情况,计算ECT诊断子宫内膜癌及不典型增生的灵敏度、特异度、阳性预测值及阴性预测值。结果 171例患者细胞学标本中23例(13.45%)标本不满意,18例(10.53%)组织学标本不满意,差异无统计学意义(P> 0.05)。患者是否绝经及子宫内膜厚度对诊刮标本满意度有一定影响,差异均具有统计学意义(P<0.05),但对细胞学标本满意情况无影响,差异无统计学意义(P>0.05)。ECT诊断子宫内膜癌的灵敏度、特异度、阳性预测值、阴性预测值分别为82.61%、98.31%、95.0%、96.67%,诊断子宫内膜不典型增生的灵敏度、特异度、阳性预测值、阴性预测值分别为78.57%、99.21%、91.67%、97.67%。结论 ECT获取的细胞学标本稳定可靠,不受患者绝经及内膜厚度的影响,诊断子宫内膜病变的准确性较高。可作为早期筛查子宫内膜病变的有效方法。
Objective To investigate the clinical significance of endometrial cytology test( ECT) in the diagnosis of endometrial disease. Methods The clinical data of 171 women with a suspect of endometrial disease and would receive diagnostic curettage from June,2017 to June,2018 in Anhui provincial hospital were collected.The cytology specimens were collected by SAP-1 endometrial cytology collector,and then diagnostic curettage was performed to obtain histological specimens. The satisfaction degree of the two collection methods was compared.The influence of menopause state and endometrial thickness affect on the adequacy of collecting specimens by these two methods was analyzed,and calculate the sensitivity,specificity,positive predictive value and negative predictive value of ECT in the diagnosis of endometrial cancer and dysplasia. Results In the 171 patients,23( 13. 45%) cases were insufficient in cytological specimens,and 18 cases( 10. 53%) were insufficient in histological specimens. The difference has no statistically significant( P > 0. 05). The menopause state and endometrial thickness play a role in the adequacy of diagnostic curettage,the difference was statistically significant( P<0.05),but mean a little to the cytological specimens,the adequacy has no statistically significant( P>0.05).The sensitivity,specificity,positive predictive value and negative predictive value of ECT in the diagnosis of endometrial cancer were 82. 61%,98. 31%,and 95. 0%,96. 67% respectively. Mean while,the sensitivity,specificity,positive predictive value and negative predictive value in the diagnosis of endometrial atypical hyperplasia were 78.57%,99.21%,and 91.67%,97.67% respectively.Conclusions The cytological specimens obtained by ECT are stable and reliable,and not affected by the menopausal state and endometrial thickness of patients. The accuracy of diagnosis of endometrial disease is high,which could be used as an effective method for early screening of endometrial diseases.
Objective To investigate the clinical significance of endometrial cytology test( ECT) in the diagnosis of endometrial disease. Methods The clinical data of 171 women with a suspect of endometrial disease and would receive diagnostic curettage from June,2017 to June,2018 in Anhui provincial hospital were collected.The cytology specimens were collected by SAP-1 endometrial cytology collector,and then diagnostic curettage was performed to obtain histological specimens. The satisfaction degree of the two collection methods was compared.The influence of menopause state and endometrial thickness affect on the adequacy of collecting specimens by these two methods was analyzed,and calculate the sensitivity,specificity,positive predictive value and negative predictive value of ECT in the diagnosis of endometrial cancer and dysplasia. Results In the 171 patients,23( 13. 45%) cases were insufficient in cytological specimens,and 18 cases( 10. 53%) were insufficient in histological specimens. The difference has no statistically significant( P > 0. 05). The menopause state and endometrial thickness play a role in the adequacy of diagnostic curettage,the difference was statistically significant( P<0.05),but mean a little to the cytological specimens,the adequacy has no statistically significant( P>0.05).The sensitivity,specificity,positive predictive value and negative predictive value of ECT in the diagnosis of endometrial cancer were 82. 61%,98. 31%,and 95. 0%,96. 67% respectively. Mean while,the sensitivity,specificity,positive predictive value and negative predictive value in the diagnosis of endometrial atypical hyperplasia were 78.57%,99.21%,and 91.67%,97.67% respectively.Conclusions The cytological specimens obtained by ECT are stable and reliable,and not affected by the menopausal state and endometrial thickness of patients. The accuracy of diagnosis of endometrial disease is high,which could be used as an effective method for early screening of endometrial diseases.
引文
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[13]褚兆苹,褚兆珍戴军,等.子宫内膜细胞学检查在绝经后女性宫腔积液中的应用[J].中国妇幼保健,2016,31(03):631-633.
[14]张保华,冯晓丹,申丽,等.子宫内膜液基细胞学检查在子宫内膜癌筛查中的效果研究[J].中国妇幼保健,2017,32(7):1402-1404.
[15] Yang X,Ma K,Chen R,et al.Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women[J]. Arch Gynecol Obstet,2017,296(1):1-7.
[16] Colombo N,Creutzberg C,Amant F,et al.ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer[J]. Int J Gynecol Cancer,2016,26:2-30.
[2] Siegel RL,Miller KD,Jemal A.Cancer Stastistics[J].CA Cancer J Clin,2017,67(1):7-30.
[3]宋冰冰,孙惠昕,陈王洋,等.2014年中国子宫体癌发病与死亡分析[J].中国肿瘤,2018,27(10):733-737.
[4] Yan oh K,Hirai Y,Sakamoto A,et al. New Terminology for intrauterine endometrial samples:a group Study by the Japanese Society of Clinical Cytology[J]. Acta Cytologica,2013,57(1):113-114.
[5]赵健.子宫内膜细胞学诊断系统[J].中国生育健康杂志,2006,16(1):6-8.
[6] Mccluggage WG. My approach to the interpretation of endometrial biopsies and curettings[J].J Clin Pathol,2006,59(8):801-812.
[7] Sliverberg SG,Mutter GL,Kurman RJ,et al.Tumors of the uterine corpus:epithelial tumors and related lesions[M]//Tavassoli FA,Stratton MR. WHO classification of tumors:pathology and genetics of tumors of the breast and female genital organs. Lyon:IARC Press,2003:221-232.
[8]杨曦,廖秦平,吴成,等.子宫内膜细胞学检查在子宫内膜癌筛查中的应用[J].中华妇产科杂志,2013,48(12):884-890.
[9]徐丕丽,文佳,张慧,等.宫腔取样与子宫内膜癌筛查研究进展[J].中国实用妇科与产科杂志,2016(9):911-914.
[10] Van HN,Prins MM,Bongers MY,et al.The accuracy of endometrial sampling in women with postmenopausal bleeding:a systematic review and meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol,2016,197:147-155.
[11]文佳,陈锐,赵健,等.子宫内膜细胞学检查在绝经后女性中的应用价值[J].实用妇产科杂志,2015,31(7):527-529.
[12] Hartman A,Wolfman W,Nayot D,et al.Endometrial thickness in 1,500asymptomatic postmenopausal women not on hormone replacement therapy[J].Gynecol Obstet Inves,2013,75(3):191-195.
[13]褚兆苹,褚兆珍戴军,等.子宫内膜细胞学检查在绝经后女性宫腔积液中的应用[J].中国妇幼保健,2016,31(03):631-633.
[14]张保华,冯晓丹,申丽,等.子宫内膜液基细胞学检查在子宫内膜癌筛查中的效果研究[J].中国妇幼保健,2017,32(7):1402-1404.
[15] Yang X,Ma K,Chen R,et al.Liquid-based endometrial cytology associated with curettage in the investigation of endometrial carcinoma in a population of 1987 women[J]. Arch Gynecol Obstet,2017,296(1):1-7.
[16] Colombo N,Creutzberg C,Amant F,et al.ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer[J]. Int J Gynecol Cancer,2016,26:2-30.
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