| Objective:The purpose of this paper is to analyze the clinical and pathological features of endometrial atypical hyperplasia patients whose postoperative pathological diagnosis is endometrial cancer,including patient’s age,preoperative sampling method,intraoperative frozen section results,operative method,postoperative pathological stages,etc.So as to provide reference,new ideas and theoretical basis for the diagnosis and treatment of related patients.Methods:A retrospective analysis was made on the clinical and pathological characteristics of 110 patients who were hospitalized in Bethune First Hospital of Jilin University from 2003 to 2017.These patients have common characteristics,such as Endometrial Atypical Hyperplasia(EAH)was diagnosed by different sampling methods before operation and total hysterectomy without fertility requirement.According to the pathology after operation,the endometrium cancer was merged or not.patients are divided into cancer group and non-cancer group.(1)By comparing the pathological results before and after Endometrial Atypical Hyperplasia patients’ operation,the rate of pathological upgrading to endometrial cancer(EC)and its pathological stages were counted,and the relevant clinical value was analyzed;(2)By comparing the age of two groups of patients,the correlation between age and pathological upgrading of EAH patients was analyzed,and the influence of age on treatment options of EAH patients was analyzed;(3)Comparing the coincidence rate and missed diagnosis rate of preoperative pathology obtained by two different sampling methods,and analyzing the accuracy of pathological acquisition by different curettage methods,so as to provide a choice for patients’ pathological acquisition methods;(4)To compare the results of intraoperative frozen section with those of postoperative pathology.According to the pathological results of intraoperative frozen section,the pathological diagnosis of EC after operation was divided into two groups: the confirmed group and the missed group,and the related factors and clinical value were analyzed.Meanwhile,evaluate the value of intraoperative frozen section for staging judgment and treatment of EAH patients during operation;(5)Some patients undergoing preventive bilateral ovariectomy to avoid secondary surgery caused by pathological upgrading after operation To compare differences between these two groups patients to provide reference for the operation scope of EAH patients.;Data were analyzed by SPSS 22.0 statistical software,and Kappa test was used to evaluate the consistency of the two pathological diagnostic methods.The measurement data conforming to normal distribution were expressed by mean ±standard deviation(x ±s)and t-test,while the counting data were expressed by rate and Chi-square(χ2),when P < 0.05,there was statistical significance.Results:(1)Pathological diagnosis of EC after operation in EAH patients was 47.57%(49/103),which means that one out of two EAH patients pathological upgrading to EC.There were 35 IA patients,accounting for 71.43%;9 IB patients,accounting for 18.37%;3 II patients,accounting for 6.12%;2 IIIA patients,accounting for 4.08%.(2)The age of cancer group and non-cancer group was 48.45±8.837 and 47.52±7.121,respectively.There was no significant difference in age between the two groups(P > 0.05),which was not considered as a high risk factor of potential canceration.(3)The rate of EC missed diagnosis in EAH patients was 50.00% by diagnostic curettage and 45.45% by hysteroscopy,respectively.The rate of EC missed diagnosis in EAH patients was slightly higher by diagnostic curettage.The diagnostic coincidence rate of hysteroscopy was 54.55%,higher than that of diagnostic curettage 50.00 %,but there was no significant difference between them(P> 0.05).(4)The detection rate of EC was 47.22%(17/36)in EAH patients by intraoperative frozen section pathology,and 35.85%(19/53)in EC patients diagnosed by intraoperative frozen section pathology.The diagnostic coincidence rate of intraoperative rapid pathology for EAH was 64.15%(34/53),for EC was 100%(17/17),for intraoperative diagnosis and post-operative pathology was 72.86%(51/70),and for intraoperative frozen section was consistent with post-operative pathological diagnosis(Kappa = 0.465 > 0.4).(5)Among 103 patients included in this study,52 patients underwent preventive resection of bilateral ovary,while othes not.Their age distribution in the region 53.02±6.761 years and 42.80±5.367 years.There was a statistical difference between the two ages(P<0.001).In ovariectomy group,endometrial cancer accounted for 55.77%(29/52),of which 25 were stage I patients,2 were stage II patients and 2 were stage III patients.Endometrial cancer accounted for 39.22%(20/51)in ovarian preservation group,of which 19 cases were stage I and 1 case was stage II.Among these patients,12 cases had lymph node resection,and no lymph node metastasis was found.Only 1 case had neurological infiltration after operation whose pathological stage is IB Conclusions:(1)Patients with atypical endometrium have a higher age of onset and a higher risk of latent cancer.Total hysterectomy is recommended for patients with no fertility requirement and older age.However,age is not a high risk factor for latent canceration in patients with atypical endometrial hyperplasia.The stage of endometrial cancer is generally earlier in those patients(2)Preoperative endometrial pathology in two different sampling method can not exclude the possibility of missed diagnosis,but there is no significant difference between the two methods.Considering all kinds of situations,we can choose Individual sampling methods.(3)The results of frozen section during operation are relative consistent with those of pathological diagnosis after operation.The missed diagnosis may be related to the situation of taking materials and the level of clinician’s experience.If conditions permit,especially when preoperative pelvic magnetic resonance suggests abnormality,we should attach importance to the rapid pathology of frozen section during operation and take materials carefully.Intraoperative rapid pathology has certain guiding significance for the the plan of operation and judge of pathological stage during operation.(5)Patients with atypical endometrial hyperplasia have a high risk of latent cancer.According to doctors’ clinical experience and condition assessment.Preventive bilateral ovariectomy is feasible for suspicious or high-risk EAH patients.Age should be considered as one of its factors. |
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