| Objective:To study the feasibility and accuracy of endometrial cytology screening for endometrial cancer screening,and to explore its clinical application value in the screening of endometrial cancer and precancerous lesions.At the same time,the risk factors of endometrial cancer and its precancerous lesions were analyzed to provide an important theoretical basis for clearing the endometrial cancer screening target population.Methods:From October 2016 to September 2017,a total of 150 patients with the symptoms of abnormal vaginal bleeding or B-ultrasound suggesting endometrial thickening or abnormal uterine cavity echo,which take a vist to the oncology and gynecology in First Affiliated Hospital of Bengbu Medical College were selected in the prospective study.The 150 cases were randomly divided into two groups,A group of patients underwent endometrial cytology and then underwent diagnostic curettage,in Group B,only diagnostic curettage was used to record the patient’s pain degree,blood volume and specimen satisfaction in the course of operation,and the difference between the two methods in specimen satisfaction,bleeding volume and pain degree was statistically significant.The diagnostic accuracy,sensitivity and specificity of endometrial cytology in Group A 75 patients were analyzed with histopathological diagnosis of diagnostic curettage as"gold standard".It also records the basic conditions of the patient,such as height,weight,occupation,birth history,etc.,and completes the risk factors questionnaire for endometrial carcinoma and precancerous lesions with informed consent.A positive index was established for the diagnosis of endometrial carcinoma and atypical hyperplasia of endometrium in histopathology.I set the negative index,combined with the statistics of high-risk factors questionnaire,the first single factor analysis of endometrial carcinoma and precancerous lesions of high-risk factors,and then the single factor analysis of the results of meaningful variables(p<0.10).The independent Risk factors(p<0.05)of endometrial carcinoma and precancerous lesion were obtained by logistic regression analysis.Results:1.The satisfactory degree of endometrial cytology was higher(96%),75patients had 72 samples satisfactory,the satisfaction of diagnostic curettage was 93.4%,75 cases were satisfactory,and there were no statistically significant difference between them(χ2=0.528,p>0.05)。2.The degree of pain in the patients with endometrial cytology was small,but the pain was more obvious in the diagnosis of curettage,the difference of pain degree was statistically significant(χ2=137.2,p<0.05).3.During endometrial cytology,the amount of hemorrhage was less,the mean bleeding was about 0.52±0.45ml,the mean bleeding of diagnostic curettage was about7.51±6.03ml,the difference was statistically significant(t=15.631,p<0.05).4.With the histopathological diagnosis of diagnostic curettage as"gold standard",the sensitivity of endometrial cytology for endometrial carcinoma and precancerous lesion screening was 87.1%(27/31),specificity was 97.73%(43/44),and positive predictive value was 96.43%(27/28),The negative predictive value was 91.49%(43/47)and the diagnostic accuracy was 95.89%(70/75),and there was no statistically significant difference compared with the diagnostic curettage(χ2=0.8,p>0.05).5.The results of single factor analysis showed that BMI≥25kg/m~2,hypertension,infertility,family history of malignant tumor and age≥45 years were the high-risk factors of endometrial carcinoma and precancerous lesion;the results of multivariate logistic regression analysis showed that BMI≥25kg/m~2,the family history of malignant tumors and the age≥45 years are independent risk factors for endometrial carcinoma and precancerous lesions.Conclusion:1.The sample of ECT is highly satisfactory,simple and easy to use,with little bleeding,little pain,and good compliance with patients,and it is feasible to screen for endometrial carcinoma and precancerous lesions.2.ECT has high diagnostic accuracy,high sensitivity and specificity.It has clinical application value and can be used as a first-line method for screening endometrial cancer and its precancerous lesions.It is worthy of promotion in clinical practice.3.Screening for endometrial cancer and precancerous lesion should be conducted annually for patients with asymptomatic high-risk groups of 45 years or older,with a BMI of 25kg/m~2 and a family history of malignant tumor.ECT is recommended to be used. |
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