| Objective:This study retrospectively analyzed the preoperative diagnosis of atypical endometrial hyperplasia(atypical endometrial hyperplasia,AEH),we aimed to evaluate the high risk factors of AEHpostoperative pathological upgraded to EC.Methods: A retrospective analysis was conducted on archival blocks diagnosed between January 2011 and June 2016 included 168 AEH patients.All patients were diagnosed with AEH and underwent a total hysterectomy within 2 months after diagnosis at Affiliated Hospital of Qingdao University,Shandong province.Pathological differences of preoperative pathology,intraoperative frozen pathology and postoperative pathology were analyzed and the guiding significance of diagnostic curettage,hysteroscopy biopsy and intraoperative frozen pathology according to the standard of postoperative paraffin pathologywere evaluated in this study.The patients were divided into two groups,including EC group(A group)and AEH group(B group),according to the postoperative pathological results.Comparative analysis of age,menopausal status and age,body mass index(BMI),clinical feature,fertility status,complication(hypertension,diabetes),family history(first-degree relatives history of malignant neoplasm),tumor markers(serum CA125,CA199)and the preoperative ultrasound status were performed in the subgroups.All the data were analyzed using SPSS 24.0 software,and p<0.05 represents statistical significance.Results: The analytical results showed,among the 168 patients,54 patients with EC(32.14%)and 114 patients with AEH(67.86%)were identified.All patients in group A were endometrial adenocarcinoma,of which 38 patients(70.37%)had a well-differentiated carcinoma,16(29.63%)patients had a moderately differentiated carcinoma and 0 patients had a poorly differentiated carcinoma,and there were 46 patients(85.19%)in stage IA,5 patients(9.26%)in stage IB,and 3 patients(5.55%)in stage II.The results of the diagnostic coincidence rate showed that the diagnostic accuracy of pathological biopsy under hysteroscopy(72.72%)was higher than diagnostic curettage(66.67%),but there was no significant difference was observed(p>0.05).The diagnostic coincidence rate of intraoperative frozen pathology for EC and AEH was 94.00% and 90.17%,respectively,and there was no significant difference was observed(p>0.05).Postoperative pathological upgrade was associated with the pathological grade of preoperative AEH,and the higher the preoperative pathological grade,the higher risk of upgrade to cancer.The probability of mild,moderate and severe AEH upgrading to EC was 4.08%(2/9),28.13%(9/32)and 59.32%(35/59),respectively,and there was a significant difference among groups(p<0.05).The probability of sever AEH upgrading to EC was significantly higher than other groups(p<0.05).Age,age of postmenopausal patients,BMI,intrauterine blood flow statue and uterine cavity were compared between A group and B group.And the results showed that age,age of postmenopausal patients,BMI and abundant blood flow signal in group A were significantly higher than in the group B,indicating that these factors may be a sensitive indicator of postoperative AEH pathological changes.However,there were no significant differences in reproductive status,comorbidities(hypertension,diabetes),family history(first-degree relatives malignancy history),tumor markers(serum CA125,CA199)between EC groupand AEH group,indicating that these factors were not associated with AEHpostoperative pathological upgrade.In conclusions:1.AEH has a canceration tendency,and most of the cancers are well differentiated and in early stage;2.Three diagnostic methods,including the diagnostic curettage,hysteroscopic biopsyhad missed diagnosis;3.intraoperative frozen section diagnosisshould be sent to improve the accuracy of diagnosis;4.The preoperative pathology was correlated with postoperative pathology;5.For patients age over 50,menopause and late menopause,obesity,preoperative abundant blood flow in uterus and unsmooth uterine cavity should vigilant to the possibility of upgrading to cancer. |
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