子宫内膜细胞学联合血清TAP检测对子宫内膜癌初筛价值
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摘要
目的子宫内膜细胞学检查(endometrial cytology,ECT)用于子宫内膜癌初筛,其准确性仍待提高。本研究评估ECT联合异常糖链糖蛋白(tumor abnormal protein,TAP)对子宫内膜癌初筛应用价值。方法选取2015-01-01-2018-10-31聊城市第二人民医院妇科收治的有子宫内膜癌高危因素的患者共350例,使用ECT和诊断性刮宫术病理检查,同时测定血清标志物CA125及TAP水平,与病理结果比较确定2种筛查方法及标志物对本病诊断价值。结果 350例子宫内膜癌患者ECT和诊断性刮宫取材满意率分别为95.7%和96.8%,差异无统计学意义,χ~2=0.639,P=0.424;ECT采集时间为(4.68±1.23)min,短于诊断性刮宫的(13.35±2.35)min,t=24.382,P=0.016;ECT出血量为(1.58±0.39)mL,少于诊断性刮宫的(13.06±2.85)mL,t=30.576,P=0.039。取材满意的335例患者采用ECT发现子宫内膜癌42例,良性病变293例;诊断性刮宫术病理发现子宫内膜癌40例,良性病变295例。子宫内膜癌患者与内膜良性病变患者比较,TAP阳性灵敏度为62.5%,高于CA125的15.0%,差异有统计学意义,χ~2=19.013,P<0.001。ECT+TAP联合筛查子宫内膜癌灵敏度为95.0%,高于ECT的77.5%,χ~2=5.165,P=0.023;ECT+TAP联合筛查特异度为86.8%,低于ECT的96.3%,χ~2=17.132,P<0.001。ECT+TAP联合筛查准确度为49.4%,低于ECT的73.8%,χ~2=7.679,P=0.006。结论 ECT联合TAP筛查安全可靠,可以作为子宫内膜癌高危人群筛查方法。
OBJECTIVE The accuracy of endometrial cytology(ECT)in the preliminary screening of endometrial carcinoma still needs to be improved.The purpose of this study was to explore the application value of ECT and tumor abnormal protein(TAP)in the early screening of endometrial cancer.METHODS Totally 350 patients with high risk of endometrial cancer were collected at the Department of Gynecology of Liaocheng Second People's Hospital From January 1,2015 to October 31,2018.All patients were treated with ECT and histological examination of diagnostic curettage and serum CA125 and TAP were detected.Pathological results were compared to determine the diagnostic value of two screening methods and markers.RESULTS There was no statistically significant difference in the satisfaction rate between ECT(95.7%)and diagnostic curettage(96.8%),χ~2=16.911,P=2.362.The collection time of ECT was shorter than that of diagnostic curettage(4.68±1.23 vs 13.35±2.35,t=24.382,P=0.016);the amount of ETC bleeding was less than that of diagnostic curettage(1.58±0.39 vs 13.06±2.85,t=30.576,P=0.039).Totally 42 cases of endometrial carcinoma and 293 cases of benign lesions were found by ECT in 335 patients with satisfactory sampling.Totally 40 cases of endometrial carcinoma and 295 cases of benign lesions were found by diagnostic curettage.Compared with patients with benign endometrial lesions,the sensitivity of TAP was higher than that of CA125(62.5% vs 15.0%,χ~2=19.013,P<0.001).The sensitivity of ECT+TAP combined screening for endometrial cancer was higher than that of ECT(95.0%vs 77.5%,χ~2=5.165,P=0.023);the specificity of ECT+TAP combined screening was lower than that of ECT(86.8%vs 96.3%,χ~2=17.132,P<0.001).The accuracy of combined screening of ECT+TAP was lower than that of ECT(49.4% vs73.8%,χ~2=7.679,P=0.006).CONCLUSION ECT combined with TAP is a safe and reliable method in screening of high-risk groups of endometrial cancer.
OBJECTIVE The accuracy of endometrial cytology(ECT)in the preliminary screening of endometrial carcinoma still needs to be improved.The purpose of this study was to explore the application value of ECT and tumor abnormal protein(TAP)in the early screening of endometrial cancer.METHODS Totally 350 patients with high risk of endometrial cancer were collected at the Department of Gynecology of Liaocheng Second People's Hospital From January 1,2015 to October 31,2018.All patients were treated with ECT and histological examination of diagnostic curettage and serum CA125 and TAP were detected.Pathological results were compared to determine the diagnostic value of two screening methods and markers.RESULTS There was no statistically significant difference in the satisfaction rate between ECT(95.7%)and diagnostic curettage(96.8%),χ~2=16.911,P=2.362.The collection time of ECT was shorter than that of diagnostic curettage(4.68±1.23 vs 13.35±2.35,t=24.382,P=0.016);the amount of ETC bleeding was less than that of diagnostic curettage(1.58±0.39 vs 13.06±2.85,t=30.576,P=0.039).Totally 42 cases of endometrial carcinoma and 293 cases of benign lesions were found by ECT in 335 patients with satisfactory sampling.Totally 40 cases of endometrial carcinoma and 295 cases of benign lesions were found by diagnostic curettage.Compared with patients with benign endometrial lesions,the sensitivity of TAP was higher than that of CA125(62.5% vs 15.0%,χ~2=19.013,P<0.001).The sensitivity of ECT+TAP combined screening for endometrial cancer was higher than that of ECT(95.0%vs 77.5%,χ~2=5.165,P=0.023);the specificity of ECT+TAP combined screening was lower than that of ECT(86.8%vs 96.3%,χ~2=17.132,P<0.001).The accuracy of combined screening of ECT+TAP was lower than that of ECT(49.4% vs73.8%,χ~2=7.679,P=0.006).CONCLUSION ECT combined with TAP is a safe and reliable method in screening of high-risk groups of endometrial cancer.
引文
[1]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.
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[5]姚淞元,吴永梅.TAP检测在消化道肿瘤诊断和预后判断中的意义[J].实用肿瘤学杂志,2015,29(2):122-126.
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[7] Plotti F,Capriglione S,Terranova C,et al.Validation of REM score to predict endometrial cancer in patients with ultrasound endometrial abnormalities:results of a new independent dataset[J].Medical Oncology,2017,34(5):82.
[8]赵健.子宫内膜细胞学诊断系统[J].中国生育健康杂志,2006,17(1):6-8.
[9]赵淑芳,刘智荣,张恒,等.应用子宫内膜采集器行液基细胞学检查对子宫内膜癌的诊断价值分析[J].癌症进展,2018,16(7):914-916.
[10] Margari N,Pouliakis A,Anoinos D,et al.A reporting system for endometrial cytology:cytomorphologic criteria-im plied risk of malignancy[J].Diagn Cytopathol,2016,44(11):888-901.
[11] Berlin NI.Tumor markers in cancer prevention and detection[J].Cancer,1981,47(5Suppl):1151-1153.
[12]史英,柳志宝,高敬华,等.肿瘤异常蛋白对消化道恶性肿瘤的表达及化疗疗效评价[J].中国综合临床,2015,31(12):1125-1127.
[13]施南峰.肿瘤异常蛋白(TAP)筛查早期恶性肿瘤应用研究[J].中国公共卫生管理,2010,26(2):187-189.
[14]陈晨,任明,高国宇,等.异常糖链糖蛋白(TAP)在甲状腺乳头状癌中表达及临床意义[J].贵州医药,2017,41(10):1014-1016.
[15]李永康,银铎.子宫内膜癌淋巴转移的危险因素分析[J].中华肿瘤防治杂志,2016,23(5):326-330.
[16]叶辉霞,李小毛,邓柳枝,等.CA125在子宫内膜癌诊断预测中的价值[J].广东医学,2014,35(16):2562-2563.
[2]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.
[3]黄平,向群,刘媛玲.子宫内膜采集器在液基细胞学联合组织学筛查子宫内膜癌中的应用[J].中国妇幼健康研究,2016,27(5):631-633.
[4] Norimatsu Y,Kouda H,Kobayashi TK,et al.Utility of thinlayer preparation in the endometrial cytology:evaluation of benign endometrial lesions[J].Ann Diagn Pathol,2008,(12):103-111.
[5]姚淞元,吴永梅.TAP检测在消化道肿瘤诊断和预后判断中的意义[J].实用肿瘤学杂志,2015,29(2):122-126.
[6]王义霞,胡涛,徐尊花,等.肿瘤异常蛋白检测系统在早期妇科恶性肿瘤筛查中的应用价值[J].中国实验诊断学,2016,20(5):745-747.
[7] Plotti F,Capriglione S,Terranova C,et al.Validation of REM score to predict endometrial cancer in patients with ultrasound endometrial abnormalities:results of a new independent dataset[J].Medical Oncology,2017,34(5):82.
[8]赵健.子宫内膜细胞学诊断系统[J].中国生育健康杂志,2006,17(1):6-8.
[9]赵淑芳,刘智荣,张恒,等.应用子宫内膜采集器行液基细胞学检查对子宫内膜癌的诊断价值分析[J].癌症进展,2018,16(7):914-916.
[10] Margari N,Pouliakis A,Anoinos D,et al.A reporting system for endometrial cytology:cytomorphologic criteria-im plied risk of malignancy[J].Diagn Cytopathol,2016,44(11):888-901.
[11] Berlin NI.Tumor markers in cancer prevention and detection[J].Cancer,1981,47(5Suppl):1151-1153.
[12]史英,柳志宝,高敬华,等.肿瘤异常蛋白对消化道恶性肿瘤的表达及化疗疗效评价[J].中国综合临床,2015,31(12):1125-1127.
[13]施南峰.肿瘤异常蛋白(TAP)筛查早期恶性肿瘤应用研究[J].中国公共卫生管理,2010,26(2):187-189.
[14]陈晨,任明,高国宇,等.异常糖链糖蛋白(TAP)在甲状腺乳头状癌中表达及临床意义[J].贵州医药,2017,41(10):1014-1016.
[15]李永康,银铎.子宫内膜癌淋巴转移的危险因素分析[J].中华肿瘤防治杂志,2016,23(5):326-330.
[16]叶辉霞,李小毛,邓柳枝,等.CA125在子宫内膜癌诊断预测中的价值[J].广东医学,2014,35(16):2562-2563.
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