Misdiagnosis Of Endometrial Carcinoma In Endometrial Atypical Hyperplasia Patients

Objective:Assess the value of diagnostic curettage, hysteroscopy diagnosis and intra-operative frozen pathology in endometrial atypical hyperplasia through a retrospective analysis. Discuss the high risk factors and possible causes of missed diagnosis of endometrial carcinomaMaterials and Methods:132cases was collected, of which all had received surgical treatment because of endometrial atypical hyperplasia from August2003to December2012in Qilu Hospital of Shandong University. Assess the value of Hysteroscopy, diagnostic curettage and intra-operative biopsy pathology in these cases through the analysis of the preoperative, intra-operative and postoperative pathology results. Classify all the cases into two groups according to the postoperative pathology:endometrial carcinoma and non-endometrial carcinoma. After that, we discussed the possible causes of missed diagnosis of endometrial carcinoma and try to find out some methods to reduce the missed diagnosis of endometrial carcinoma by comparing the factors such as age, body mass index,menopausal status, menstrual and reproductive history, complications and thickness of the endometrium shown by ultrasound. Use the statistical software SPSS1.6to deal with the data.Results: 1. Endometrial carcinoma was observed in42(31.82%) of132cases, endometrial atypical hyperplasia42(31.82%) cases,48(36.36%) cases did not exhibit atypia.2. Preoperative and postoperative pathological coincidence rate of hysteroscopy and diagnostic curettage is31.43%,31.96%separately, missed diagnostic rate of endometrial carcinoma is28.57%,32.99%separately.3. Missed diagnostic rate of intra-operative biopsy pathology is27.5%.4. Ⅰa, Ⅰb,Ⅲa,Ⅲb occupies90.48%,4.76%,2.38%separately in the cases which has been confirmed to endometrial carcinoma, including high, medium and low differentiated ones80.95%,11.90%,7.14%respectively.5. We did not find any statistical association between anyone of age, menopausal status, body mass index, hypertension, diabetes mellitus and endometrial carcinoma cases. Long history of menstrual disorders, no reproductive history and thickening of endometrium suggests high risk of endometrial carcinoma.Conclusions:The missed diagnostic rate of endometrial carcinoma is high in the patients who has been diagnosed with endometrial atypical hyperplasia by diagnostic curettage or hysteroscopy diagnosis, and of which, the latter didn’t show a significant advantage in the diagnosis. Intra-operative frozen section played a limited role in the diagnosis of endometrial carcinoma and as a result of that, a secondary surgery may be needed. Most of the cases confirmed as endometrial carcinoma, always have a high differentiation degree and a early stage.Endometrial carcinoma is on our guard when combined with obesity, especially the ones BMI≤28, no reproductive history, long time of menstrual disorders, thickening of endometrium. Individual treatment scheme should be established based on sufficient assessment of one’s age, reproduction requirement, healthy status and the risk of incidence of endometrial carcinoma.