负压型子宫内膜取样器用于筛查子宫内膜癌的临床进展
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摘要
子宫内膜癌是女性生殖系统常见的恶性肿瘤,由于生活水平的提高以及缺少有效的筛查方法,子宫内膜癌的发病率在不断上升。及早发现子宫内膜癌及癌前病变,将显著改善患者的预后并提高生存率。目前,我国缺少与宫颈癌筛查一样可以筛查子宫内膜病变的方法。近年问世的子宫内膜取样器具有操作简便、费用低、创伤小的优点,在国外逐渐被用于子宫内膜癌及癌前病变的临床筛查。本文总结、分析了目前子宫内膜癌及癌前病变的筛查方法以及采用子宫内膜取样器进行子宫内膜病变筛查的临床进展。
Endometrial cancer is a common malignancy of the female reproductive system. Despite improvement in living standards,the incidence of endometrial cancer is increasing due to the lack of effective screening. Early detection of endometrial cancer and precancerous lesions can significantly improve prognosis and survival. At present,China lacks a method for screening endometrial lesions comparable to that for cervical cancer screening. A recently introduced endometrial sampler has the advantages of simple operation,low cost,and minimal trauma,and is gradually being accepted for clinical screening of endometrial cancer and precancerous lesions in other countries.This study aims to explore current screening methods for endometrial cancer and precancerous lesions and the clinical application of an endometrial sampler for screening.
Endometrial cancer is a common malignancy of the female reproductive system. Despite improvement in living standards,the incidence of endometrial cancer is increasing due to the lack of effective screening. Early detection of endometrial cancer and precancerous lesions can significantly improve prognosis and survival. At present,China lacks a method for screening endometrial lesions comparable to that for cervical cancer screening. A recently introduced endometrial sampler has the advantages of simple operation,low cost,and minimal trauma,and is gradually being accepted for clinical screening of endometrial cancer and precancerous lesions in other countries.This study aims to explore current screening methods for endometrial cancer and precancerous lesions and the clinical application of an endometrial sampler for screening.
引文
[1]CHEN W,ZHENG R,BAADE PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.DOI:10.3322/caac.21338.
[2]王志启,王建六.年轻未生育妇女子宫内膜癌保留生育功能的治疗[J].实用妇产科杂志,2012,28(7):521-523.DOI:10.3969/j.issn.1003-6946.2012.07.004.
[3]SIEGEL RL,MILLER KD,JEMAL A.Cancer statistics,2016[J].CACancer J Clin,2016,66(1):7-30.DOI:10.3322/caac.21332.
[4]陈小琳,金平,赵娟,等.改良的子宫内膜取样器在子宫内膜病变活检早期诊断中的应用[J].中国实验诊断学,2015,19(7):1096-1098.
[5]GOLDSTEIN SR.The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium[J].Am JObstet Gynecol,2009,201(1):5-11.DOI:10.1016/j.ajog.2009.02.006.
[6]AKBAYIR O,CORBACIOGLU A,NUMANGOGLU C,et al.Combined use of preoperative transvaginal ultrasonography and intraoperative gross examination in the assessment of myometrial invasion in endometrial carcinoma[J].Eur J Obstet Gynecol Reprod Biol,2012,165(2):284-288.DOI:10.1016/j.ejogrb.2012.07.005.
[7]FERNANDEZPARRA J,RODRIGUEZ OA,LOPEZ CS,et al.Hysteroscopic evaluation of endometrial polyps[J].Int J Gynaecol Obstet,2006,95(2):144-148.DOI:10.1016/j.ijgo.2006.07.007.
[8]PRENDERGAST EN,MISCH E,CHOU YA,et al.Insufficient endometrial biopsy results in women with abnormal uterine bleeding[J].Obstet Gynecol,2014,123 Suppl 1(3):180S-181S.DOI:10.1097/01.AOG.0000447198.97678.55.
[9]JACOBS L,GENTRY-MAHARAJ A,BURNELL M,et al.Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women:a case-control study within the UKCTOCS cohort[J].Lancet Oncol,2011,12(1):38-48.DOI:10.1016/S1470-2045(10)70268-0.
[10]TIMMERMANS A,OPMEER BC,KHANK S,et al.Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding:a systematic review and meta-analysis[J].Obstet Gynecol,2010,116(1):160-167.DOI:10.1097/AOG.0b013e3181e3e7e8.
[11]SUHBURGMANN E,HUNG YY,ARMSTRONG MA.Complex atypical endometrial hyperplasia:the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage[J].Obstet Gynecol,2009,114(3):523-529.DOI:10.1097/AOG.0b013e3181b190d5.
[12]TORRES ML,WEAVER AL,KUMAR S,et al.Risk factors for developing endometrial cancer after benign endometrial sampling[J].Obstet Gynecol,2012,120(5):998-1004.DOI:http://10.1097/AOG.0b013e31826b9fef.
[13]NEUBAUER NL,HAVRILESKY LJ,CALINGAERT B,et al.The role of lymphadenectomy in the management of preoperative grade 1endometrial carcinoma[J].Gynecol Oncol,2009,112(3):511-516.DOI:10.1016/j.ygyno.2008.11.012.
[14]TANGJITGAMOL S,ANDERSON BO,SEE HT,et al.Management of endometrial cancer in Asia:consensus statement from the Asian Oncology Summit 2009[J].Lancet Oncol,2009,10(11):1119-1127.DOI:10.1016/S1470-2045(09)70290-6.
[15]CLARK TJ,VOIT D,GUPTA JK,et al.Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia:a systematic quantitative review[J].JAMA,2002,288(13):1610-1621.DOI:10.1001/jama.288.13.1610.
[16]张玉敏.宫腔镜检查与诊断性刮宫在诊断子宫内膜息肉中的比较[J].中国医药指南,2013,11(10):271-271.DOI:10.15912/j.cnki.gocm.2013.10.476.
[17]CHANG YN,ZHANG Y,WANG YJ,et al.Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells:a meta-analysis[J].Fertil Steril,2011,96(4):957-961.DOI:10.1016/j.fertnstert.2011.07.1146.
[18]朴曙花,冯文宵,李艳霞,等.宫腔镜在子宫内膜病变诊治中的应用[J].中国医学创新,2015,12(28):136-139.DOI:10.3969/j.issn.1674-4985.2015.28.043.
[19]杨宝华,艾志宏.子宫内膜癌的筛查现状[J].诊断学理论与实践,2016,15(2):202-204.DOI:10.16150/j.1671-2870.2016.02.026.
[20]陈燕娥,吴学明,陈绵.血清HE4、CA125联合检测对子宫内膜癌的诊断价值[J].海南医学,2016,27(7):1054-1056.DOI:10.3969/j.issn.1003-6350.2016.07.00.
[21]李町希,杨晓霞.HE4、CA125及MRI单项和联合检测对子宫内膜癌淋巴结转移的预测价值[J].深圳中西医结合杂志,2017,27(13):42-44.DOI:10.16458/j.cnki.1007-0893.2017.13.021.
[22]REMONDI C,SEST F,BONANNO E,et al.Diagnostic accuracy of liquid-based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women[J].Cytopathology,2013,24(6):365-371.DOI:10.1111/cyt.12013.
[23]MARASINGHE JP,CHINTANA HDK,KARUNANANDA SA,et al.Liquid-based endometrial cytology:its possible value in postmenopausal asymptomatic women[J].Int J Gynecol Cancer,2007,17(4):182-187.DOI:10.1111/j.1525-1438.2007.00918.x.
[24]FAMBRINI M,BUCCOLIERO AM,PIERALLI A,et al.A pilot study evaluating liquid-based endometrial cytology and transvaginal ultrasonography in women with postmenopausal bleeding[J].Cytopathology,2013,24(6):402-403.DOI:10.1111/cyt.12027.
[25]DIJKHUIZEN PF,MOL BW,BROLMANN HA,et al.The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia:a meta-analysis[J].Cancer,2000,89(8):1765-1772..
[26]吴欢,孙桂芳,尹香花.子宫内膜采集技术在子宫内膜癌早期诊断中的应用进展[J].现代妇产科进展,2016,25(6):475-476.DOI:10.13283/j.cnki.xdfckjz.2016.06.031.
[27]WILLIAMS AR,BRECHIN S,PORTER AJ,et al.Factors affecting adequacy of Piepelle and Tao Brush endometrial sampling[J].BJOG,2008,115(8):1028-1036.DOI:10.1111/j.1471-0528.2008.01773.x.
[28]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,2016,32(9):911-914.DOI:10.7504/fk2016080123.
[29]欧俊,蒋铮,惠宁.子宫内膜细胞采集在子宫内膜癌早期诊断中的应用[J].中国生育健康杂志,2006,17(3):149-151.DOI:10.3969/j.issn.1671-878X.2006.03.006.
[30]李岚,张保华,冯晓丹,等.宫腔刷取子宫内膜的细胞学及有形成分组织学联合诊断对子宫内膜癌筛查价值的研究[J].医药论坛杂志,2017,38(1):12-15.
[31]杨将,李环,胡艳,等.采用不同子宫内膜取样器实施子宫内膜活检的诊断价值分析[J].中国妇产科临床杂志,2017,4(18):297-300.DOI:10.13390/j.issn.1672-1861.2017.04.003.
[32]胡艳,杨将,李环,等.JUSO子宫内膜取样器在诊断子宫内膜病变中的临床价值分析[J].新医学,2017,7(48):478-481.DOI:10.3969/j.issn.0253-9802.2017.07.010.
[33]张英兰,赵雨,吕昌帅,等.细胞学联合组织学在子宫内膜病变无创筛查中的应用价值[J].现代妇产科进展,2016,25(1):19-21.DOI:10.13283/j.cnki.xdfckjz.2016.01.005.
[34]DU J,LI Y,LV S,et al.Endometrial sampling devices for early diagnosis of endometrial lesions[J].J Cancer Res Clin Oncol,2016,142(12):1-8.DOI:10.1007/s00432-016-2215-3.
[2]王志启,王建六.年轻未生育妇女子宫内膜癌保留生育功能的治疗[J].实用妇产科杂志,2012,28(7):521-523.DOI:10.3969/j.issn.1003-6946.2012.07.004.
[3]SIEGEL RL,MILLER KD,JEMAL A.Cancer statistics,2016[J].CACancer J Clin,2016,66(1):7-30.DOI:10.3322/caac.21332.
[4]陈小琳,金平,赵娟,等.改良的子宫内膜取样器在子宫内膜病变活检早期诊断中的应用[J].中国实验诊断学,2015,19(7):1096-1098.
[5]GOLDSTEIN SR.The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium[J].Am JObstet Gynecol,2009,201(1):5-11.DOI:10.1016/j.ajog.2009.02.006.
[6]AKBAYIR O,CORBACIOGLU A,NUMANGOGLU C,et al.Combined use of preoperative transvaginal ultrasonography and intraoperative gross examination in the assessment of myometrial invasion in endometrial carcinoma[J].Eur J Obstet Gynecol Reprod Biol,2012,165(2):284-288.DOI:10.1016/j.ejogrb.2012.07.005.
[7]FERNANDEZPARRA J,RODRIGUEZ OA,LOPEZ CS,et al.Hysteroscopic evaluation of endometrial polyps[J].Int J Gynaecol Obstet,2006,95(2):144-148.DOI:10.1016/j.ijgo.2006.07.007.
[8]PRENDERGAST EN,MISCH E,CHOU YA,et al.Insufficient endometrial biopsy results in women with abnormal uterine bleeding[J].Obstet Gynecol,2014,123 Suppl 1(3):180S-181S.DOI:10.1097/01.AOG.0000447198.97678.55.
[9]JACOBS L,GENTRY-MAHARAJ A,BURNELL M,et al.Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women:a case-control study within the UKCTOCS cohort[J].Lancet Oncol,2011,12(1):38-48.DOI:10.1016/S1470-2045(10)70268-0.
[10]TIMMERMANS A,OPMEER BC,KHANK S,et al.Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding:a systematic review and meta-analysis[J].Obstet Gynecol,2010,116(1):160-167.DOI:10.1097/AOG.0b013e3181e3e7e8.
[11]SUHBURGMANN E,HUNG YY,ARMSTRONG MA.Complex atypical endometrial hyperplasia:the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage[J].Obstet Gynecol,2009,114(3):523-529.DOI:10.1097/AOG.0b013e3181b190d5.
[12]TORRES ML,WEAVER AL,KUMAR S,et al.Risk factors for developing endometrial cancer after benign endometrial sampling[J].Obstet Gynecol,2012,120(5):998-1004.DOI:http://10.1097/AOG.0b013e31826b9fef.
[13]NEUBAUER NL,HAVRILESKY LJ,CALINGAERT B,et al.The role of lymphadenectomy in the management of preoperative grade 1endometrial carcinoma[J].Gynecol Oncol,2009,112(3):511-516.DOI:10.1016/j.ygyno.2008.11.012.
[14]TANGJITGAMOL S,ANDERSON BO,SEE HT,et al.Management of endometrial cancer in Asia:consensus statement from the Asian Oncology Summit 2009[J].Lancet Oncol,2009,10(11):1119-1127.DOI:10.1016/S1470-2045(09)70290-6.
[15]CLARK TJ,VOIT D,GUPTA JK,et al.Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia:a systematic quantitative review[J].JAMA,2002,288(13):1610-1621.DOI:10.1001/jama.288.13.1610.
[16]张玉敏.宫腔镜检查与诊断性刮宫在诊断子宫内膜息肉中的比较[J].中国医药指南,2013,11(10):271-271.DOI:10.15912/j.cnki.gocm.2013.10.476.
[17]CHANG YN,ZHANG Y,WANG YJ,et al.Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells:a meta-analysis[J].Fertil Steril,2011,96(4):957-961.DOI:10.1016/j.fertnstert.2011.07.1146.
[18]朴曙花,冯文宵,李艳霞,等.宫腔镜在子宫内膜病变诊治中的应用[J].中国医学创新,2015,12(28):136-139.DOI:10.3969/j.issn.1674-4985.2015.28.043.
[19]杨宝华,艾志宏.子宫内膜癌的筛查现状[J].诊断学理论与实践,2016,15(2):202-204.DOI:10.16150/j.1671-2870.2016.02.026.
[20]陈燕娥,吴学明,陈绵.血清HE4、CA125联合检测对子宫内膜癌的诊断价值[J].海南医学,2016,27(7):1054-1056.DOI:10.3969/j.issn.1003-6350.2016.07.00.
[21]李町希,杨晓霞.HE4、CA125及MRI单项和联合检测对子宫内膜癌淋巴结转移的预测价值[J].深圳中西医结合杂志,2017,27(13):42-44.DOI:10.16458/j.cnki.1007-0893.2017.13.021.
[22]REMONDI C,SEST F,BONANNO E,et al.Diagnostic accuracy of liquid-based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women[J].Cytopathology,2013,24(6):365-371.DOI:10.1111/cyt.12013.
[23]MARASINGHE JP,CHINTANA HDK,KARUNANANDA SA,et al.Liquid-based endometrial cytology:its possible value in postmenopausal asymptomatic women[J].Int J Gynecol Cancer,2007,17(4):182-187.DOI:10.1111/j.1525-1438.2007.00918.x.
[24]FAMBRINI M,BUCCOLIERO AM,PIERALLI A,et al.A pilot study evaluating liquid-based endometrial cytology and transvaginal ultrasonography in women with postmenopausal bleeding[J].Cytopathology,2013,24(6):402-403.DOI:10.1111/cyt.12027.
[25]DIJKHUIZEN PF,MOL BW,BROLMANN HA,et al.The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia:a meta-analysis[J].Cancer,2000,89(8):1765-1772..
[26]吴欢,孙桂芳,尹香花.子宫内膜采集技术在子宫内膜癌早期诊断中的应用进展[J].现代妇产科进展,2016,25(6):475-476.DOI:10.13283/j.cnki.xdfckjz.2016.06.031.
[27]WILLIAMS AR,BRECHIN S,PORTER AJ,et al.Factors affecting adequacy of Piepelle and Tao Brush endometrial sampling[J].BJOG,2008,115(8):1028-1036.DOI:10.1111/j.1471-0528.2008.01773.x.
[28]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,2016,32(9):911-914.DOI:10.7504/fk2016080123.
[29]欧俊,蒋铮,惠宁.子宫内膜细胞采集在子宫内膜癌早期诊断中的应用[J].中国生育健康杂志,2006,17(3):149-151.DOI:10.3969/j.issn.1671-878X.2006.03.006.
[30]李岚,张保华,冯晓丹,等.宫腔刷取子宫内膜的细胞学及有形成分组织学联合诊断对子宫内膜癌筛查价值的研究[J].医药论坛杂志,2017,38(1):12-15.
[31]杨将,李环,胡艳,等.采用不同子宫内膜取样器实施子宫内膜活检的诊断价值分析[J].中国妇产科临床杂志,2017,4(18):297-300.DOI:10.13390/j.issn.1672-1861.2017.04.003.
[32]胡艳,杨将,李环,等.JUSO子宫内膜取样器在诊断子宫内膜病变中的临床价值分析[J].新医学,2017,7(48):478-481.DOI:10.3969/j.issn.0253-9802.2017.07.010.
[33]张英兰,赵雨,吕昌帅,等.细胞学联合组织学在子宫内膜病变无创筛查中的应用价值[J].现代妇产科进展,2016,25(1):19-21.DOI:10.13283/j.cnki.xdfckjz.2016.01.005.
[34]DU J,LI Y,LV S,et al.Endometrial sampling devices for early diagnosis of endometrial lesions[J].J Cancer Res Clin Oncol,2016,142(12):1-8.DOI:10.1007/s00432-016-2215-3.