| ObjectiveThe purpose of this study was to investigate the clinical factors associated with missed diagnosis of EC in patients who have EAH,to analyze the accuracy of diagnose EC in patients with EAH and the factors of missed diagnosis,by preoperative method of endometrium and intraoperative frozen pathological.MethodsIn this study,36 cases were collected and retrospectively analyzed,of which all had received surgical treatment for EAH in Tianjin First Central Hospital from June1st,2013 to December 31st,2017.By comparing the preoperative and postoperative pathology,work out the incidence of EC in EAH patients,and assess the value of dilation&curettage and hysteroscopy guided endometrial biopsy in the diagnosis of EAH.By comparing the intraoperative and postoperative pathology,to evaluate the accuracy of intraoperative frozen pathology in diagnosing EAH and the consistency of postoperative paraffin pathology diagnosis.And then,according to the intraoperative frozen pathology,all the cases with EC were partitioned into two groups:EC missed diagnosis group and EC confirmed diagnosis group.By comparing the clinical data of two groups,explore the clinical factors of intraoperative frozen pathology for missed diagnosis of EC.According to the postoperative paraffin pathology,all the cases were partitioned into two groups:EC group and non-EC group,By comparing the clinical data of two groups,explore the clinical factors of missed diagnosis of EC in patients with EAH.SPSS 22.0 was utilized to deal with data,count data were compared by Fisher exact probability method,while the measurement data by t test or Mann-Whitney test,Kappa test was used to evaluate the consistency of the two pathology diagnostic methods,the definition of a P value of less than 0.05 is reckoned to be statistically significant.Results1.In patients with EAH,the incidence of EAH with EC is 36.1%?13/36?,all patients were in early stage of high differentiation endometrial adenocarcinoma.2.The missed diagnosis rate for endometrial carcinoma of dilatation and curettage and hysteroscopy guided biopsy were 45%and 25%respectively in the diagnosis of EAH,and the coincidence rate of which were 30%and 50%respectively.Both missed diagnosis rate and coincidence rate of these two methods had no statistically significant difference?p=0.301,p=0.307?.3.In patients with pathological diagnosis of EC after EAH surgery,intraoperative frozen pathology and postoperative paraffin pathological diagnosis were less consistent?kappa=0.489,p=0.006?,the diagnostic specificity,sensitivity,the negative predictive value and positive predictive value were100%,50%,64.7%,100%,respectively,and the missed diagnosis rate was 50%?6/12?.4.In the cases of EC diagnosed by intraoperative frozen pathology,the histological type,degree of differentiation and depth of uterine muscular infiltration were consistent with the postoperative paraffin patholigical examination results.5.The average age of patients in the EC missed diagnosis group and proportion above 50 years old was significantly lower than EC confirmed groups,.The mean BMI of patients in the EC missed diagnosis group and proportion above 28kg/m2 was significantly lower than EC confirmed groups,Conclusions1.Preoperative segmental curettage or hysteroscopy guided endometrial biopsy had a higher missed diagnosis rate in patients with EAH,however,most were early staged well differentiation endometrial adenocarcinoma.2.Compared with sectional curettage,hysteroscopy guided endometrial biopsy has no significant advantage in diagnosing EC in patients with EAH,and that may be related to the fewer cases in this group.3.In patients with EAH,intraoperative frozen pathology had a certain leakage in diagnosing EC,which need to combine the patient's age,obesity and other high-risk factors for comprehensive analysis and judgment.In patients with high risk facors,surgens should be sufficiently communicated with the pathologist,to increase the quantity of endometrial sample,in order to reduce the rate of missed diagnosis. |
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