Analysis The Risk Factors For Misdiagnosis Of Endometrial Carcinoma In Patients With Atypical Endometrial Hyperplasia

Objective:Exploreriskfactors formisdiagnosis ofendometrial carcinoma（ECa）in patients with atypical endometrial hyperplasia（AEH）by analyzing the clinicopathological datas,and predict individual risk forecast nomogram model to reduce the missdiagnosis rate as far as possible which may provide guidance for clinical diagnosis and treatment decisions.Method:A retrospective analysis was conducted on the clinical data of 179 cases of patients subjected to total hysterectomy,with a histological diagnosis of atypical endometrial hyperplasia by dilatation and curettage or hysteroscopy endometrial biopsy in our hospital from January 1,2012 to December 31,2018.According to postoperative paraffin pathology,the patients were divided into AEH group（113 cases）and ECa group（66 cases）.We compared the related factors between the two groups,such as age,height,weight and clinical manifestation.We explored the high risk factors for misdiagnosis of ECa in patients with AEH,such as menopausal status,reproductive history,hypertension,diabetes,family history,pelvic ultrasound before the endometrium is drawn,apparent diffusion coefficient（ADC）value in pelvic MRI diffusion weighted imaging（DWI）sequence,serum CA125、CA199.The obtained data were analyzed with t-test,Chi-Square test、ROC analysis、multi-factor conditional logistic regression analyses by using SPSS23.0 software.Anomogram model was established to predict misdiagnosis of ECa in patients with AEH,and the accuracy and consistency of the model were verified by internal sampling.Rusults:1.Preoperative diagnosis of atypical endometrial hyperplasia included 179 cases,and pathologic diagnosis of endometrial cancer after total hysterectomy included 66 cases,with 36.87%（66/179）of missed diagnosis,including 65 cases of endometrial adenocarcinoma and 1 case of mixed endometrial carcinoma（clear cell and endometrial adenocarcinoma）.Ia,Ib,II,III occupies 84.85%（56/66）,4.55%（3/66）,7.57%（5/66）,3.03%（2/66）.High（G1）,medium（G2）differentiated occupies 81.54%（53/65）,18.46%（12/65）,not found low differentiation（G3）.2.The results of intraoperative frozen pathology in the dignosis of endometrial cancer:the missed diagnosis is 17.19%,the accuracy rate is 89.83%,the sensitivity、specificity,positive predictive value,negative predictive value is 82.81%、93.88%、89.83%、89.32%.3.According to the method of endometrial sampling before surgery,the patients were divided into two,including the curettage group and the hysteroscopy group.The rate of missed diagnosis of endometrial cancer in the two groups was 39.04%（57/146）and27.27%（9/33）,respectively.Although the rate of missed diagnosis of hysteroscopy group was lower than the curettage group,the difference was not statistically significant.4.Analysis of clinical risk factors for missed diagnosis of endometrial cancer:After single factor analysis,age,menopausal status,infertility history,abnormal uterine bleeding,hypertension,and ADC value were screened for statistical significance.Multi-factor analysis results indicate:age（OR 1.063,95%CI:1.001-1.063）,infertility history（OR 6.354,95%CI:1.398-28.875）,ADC value（OR 0.975,95%CI:0.960-0.991）,which were statistically significant.By plotting ROC curves,the age and ADC cutoff values were calculated to be 49.5 years old and 110x-5mm2/s,respectively.The combined prediction value of the three factors was significantly higher than that of the independent factors.5.Proportion of overweight,obese,hypertension and diabetes patients in ECa group and AEH group:overweight patients were 43.94%,37.17%,obese patients were 15.15%,13.27%,hypertension patients were 36.36%,22.12%,diabetes patients were 27.03%,15.29%,the differences were not statistically significant,but the proportion of ECa group was higher than AEH group,and significantly higher than the prevalence of the population.6.Based on the results of Logistic regression analysis,a model was constructed to predict the misdiagnosis of ECa in patients with AEH,and a nomogram was drawn.The consistency coefficient（c-index）obtained from the Bootstrap self-sampling method after internal validation of the nomogram model was 0.740,suggesting the nomogram has certain clinical predictive value.Conclusion:1.The incidence of missed ECa in the patients with AEH after hysterectomy was36.87%,and most of the missed ECa were highly differentiated early endometrioid adenocarcinoma.2.The rate of missed diagnosis of ECa after hysterectomy in the patients with by intraoperative frozen pathology examination was as high as 17.19%,with a certain false negative.3.The rate of missed diagnosis of ECa in hysteroscopy group and curettage group was27.27%and 39.04%,with no statistical significance.It is not believed that hysteroscopy endometrial biopsy can completely replace dilatation and curettage.4.The AEH patients with overweight,obesity,hypertension,diabetes,need to be aware of the risk of missed diagnosis of ECa.5.Age≥49.5 years old,history of infertility,ADC value 110x^-5mm²/s were the high risk factors for missed diagnosis of ECa in the patients with AEH.The combined prediction value of the three factors was significantly higher than that of the independent factors.6.To build a nomogram model based on the prediction of missed diagnosis ECa in the patients with AEH,which has certain prediction accuracy,can be used to individually assess the risk of ECa in the patients with AEH.