| Objective:In clinical work, gynecologists often deal with patients who are preoperatively diagnosed as atypical endometrial hyperplasia(AEH) from dilation and curettage specimens, while then diagnosed as or with endometrial adenocarcinoma(EAC) from hysterectomy specimens. This results from that the difference between AEH and EAC mainly lies in whether there’s infiltration in endometrial stroma and myometrium, which can usually be clearly identified after hysterectomy. Therefore, it is of great clinical value for both gynecologists and patients to precisely diagnose AEH. Our study aims at evaluating the diagnostic accuracy of AEH by different methods through a retrospective study of 120 cases, who were diagnosed as AEH before surgery form January 2010 to April 2014 in the Fourth Afflicted Hospital of Hebei Medical University.Methods:We collected 120 cases that were diagnosed as AEH before surgery and underwent hysterectomy afterwards, form January 2010 to April 2014 in the Fourth Afflicted Hospital of Hebei Medical University. Among the 120 cases, 65 cases were still diagnosed as AEH after surgery, while 55 cases were elsewhere diagnosed as EAC. These cases were grouped by preoperative diagnostic method, age, BMI index, with or without childbearing history and consultation of another hospital. Statistical analysis was performed by SPSS 19.0 software using Chi-square test and all statistical tests were considered significant at P<0.05.Results:1 Among 120 cases, 78 cases were preoperatively diagnosed as AEH by endometrial curettage technique,with 28 cases(35.90%) postoperatively diagnosed as AEH and 42 cases(64.10%) otherwise diagnosed as EAC after surgery. While 42 cases were preoperatively diagnosed as AEH by endometrial biopsy under hysteroscopy, with 37 cases(88.10%) postoperatively diagnosed as AEH and 5 cases(11.90%) otherwise diagnosed as EAC after surgery.2 Among the cases postoperatively diagnosed as AEH, the percentage of cases whose age was under 35, between 35 and 45, between 45 and 55, and above 55, was 3.07%, 35.38%, 46.15% and 15.38% respectively. However, among the cases postoperatively diagnosed as EAC, the percentage of cases whose age was under 35, between 35 and 45, between 45 and 55, and above 55, was 0%, 18.18%, 38.18% and 43.64%, respectively.3 Among 65 cases postoperatively diagnosed as AEH, 2 cases(3.07%) had childbearing history while other 63 cases didn’t. However, among 55 cases postoperatively diagnosed as EAC, 3 cases(5.45%) had childbearing history while other 52 cases didn’t.4 Among 65 cases postoperatively diagnosed as AEH, the number of cases with BMI index between 18.5 and 24.9(which accounts for average weight) was 8(46.15%), and that with BMI index above 25(which accounts for overweight) was 35(53.85%). However, among 55 cases postoperatively diagnosed as EAC, the number of cases with BMI index between 18.5 and 24.9 was 12(14.55%), and that with BMI index above 25 was 9(42.86%).5 13 of 120 patients requested a consultation from other hospital(the Third Afflicted Hospital of Peking University) before surgery, with 8 cases(61.54%) still diagnosed as AEH and 5 cases(38.46%) diagnosed as highly differentiated EAC. 21 cases who were postoperatively diagnosed as AEH, requested a consultation, with 12 cases(57.14%) still diagnosed as AEH and 9 other cases(42.86%) diagnosed as highly differentiated EAC.Conclusions:1 Endometrial curettage technique is relatively less specific to the diagnose of AEH, while endometrial biopsy under hysteroscopy has a relative higher specificity.2 The ages of patients who are subject to AEH distribute above 35. The number of incidence cases is positively correlated with age. So are the omission diagnose rate and the rate with EAC.3 Not having childbearing history is only a risk factor of AEH, but not of significant value to AEH diagnose.4 The omission diagnose rate of EAC is positive correlated with BMI index.5 The diagnose results from pathologists from different hospital are not consistent. |
PDF Full Text Request