Significance Of Hysteroscopy For The Diagnosis Of Endometrial Atypical Hyperplasia With Endometrioid Adenocarcinoma

Objective Endometrial atypical hyperplasia(EAH)is an abnormal endometrial hyperplasia with glandular dysplasia,which is a precancerous lesion of endometrial adenocarcinoma.Some literatures suggest that31.82%-62.6% of endometrial atypical hyperplasia and endometrioid adenocarcinoma exist simultaneously,17% of patients with severe endometrial hyperplasia were diagnosed with endometrial cancer after surgery.The “gold standard” for endometrial atypical hyperplasia diagnosis is pathological examination.Traditional curettage,endometrial biopsy,and other diagnosis methods under blind-sight may occur to miss the lesion and destroy the integrity of the lesion.Combined with the pathological identification of endometrial adenocarcinoma and its precancerous lesions is difficult,so it often happens that patients with endometrial atypical hyperplasia are upgraded to diagnose endometrial cancer after surgery,which affects the patient's treatment plan and prognosis.In recent years,hysteroscopy has gradually been applied to the diagnosis of endometrial atypical hyperplasia,and most people believe that hysteroscopy combinedwith pathological diagnosis can improve the accuracy of endometrial disease diagnosis.This study aims to explore the significance of hysteroscopy in the diagnosis of endometrial atypical hyperplasia with early endometrioid adenocarcinoma,analyze the influence factors of atypical hyperplasia combined endometrial carcinoma,help the clinician to formulate the corresponding diagnosis and treatment plan according to the patient's condition and requirements during the diagnosis and treatment.Methods The clinical data of 112 patients who underwent total hysterectomy due to preoperative pathological diagnosis of atypical endometrial hyperplasia were retrospectively analyzed.The endometrial materials were divided into groups according to the different methods of endometrial sampling.Clinical data was collected,such as age,whether menopause,preoperative B-ultrasound,diagnosis of hysteroscopy,and pathological examination results.The pathological diagnosis and clinical diagnosis of different methods of endometrial sampling were compared before and after surgery,and the clinical characteristics of patients with pathological diagnosis upgraded after surgery were compared with those of patients still diagnosed with endometrial atypical hyperplasia.Data were analyzed using SPSS 23.0 statistical software.Measurement data was expressed as(x ± s),data comparison was performed using t test.Count data was expressed as percentage,data comparison was performed using ?2 test.Influence factors for endometrial cancer in patients with endometrial atypical hyperplasia were analyzed using Logistic regression analysis.P<0.05 was considered statistically significant.Results A total of 27 cases(24.1%)of pathological diagnosis upgraded to endometrial cancer after surgery.Of the 27 patients diagnosed with endometrioid adenocarcinoma,16 were highly differentiated cancers(59.3%),1 was moderately-highly differentiated(3.7%),8 were moderately differentiated(29.6%),1(3.7%)was moderate-lowly differentiated,and1(3.7%)was lowly differentiated.In these patients,23 cases(85.2%)had stage Ia endometrioid adenocarcinoma,and 4 cases(14.8%)had stage Ib endometrioid adenocarcinoma.The rate of missed diagnosis of direct curative curettage pathological diagnosis without hysteroscopy for endometrial cancer was 23.4%,and the rate of missed diagnosis of preoperative pathological diagnosis of endometrial samples with hysteroscopy was 25%,between there was no statistical difference(P>0.05).The coincidence rate of endometrial histopathological diagnosis and postoperative diagnosis of direct diagnostic curettage was 76.6%,which was lower than the coincidence rate of 91.7% between preoperative clinical diagnosis and postoperative diagnosis of the endometrial sampling group assisted by hysteroscopy,and the difference was statistically significant(P<0.05).The preoperative and postoperative clinical diagnosis coincidence rate of the hysteroscopy after diagnostic curettage group was 88.1%,which was slightly lower than the coincidence rate of the hysteroscopy-assisted endometrial material group of 91.7%,but there was no significant statistical difference between the two(P > 0.05).According to Logisticregression analysis,menopausal status was an influence factor for patients of atypical hyperplasia combined endometrial carcinoma(OR> 1,P <0.05).Conclusion Patients with endometrial atypical hyperplasia have a higher risk of early endometrioid adenocarcinoma.So patients with fertility requirements need to closely assess the possibility of endometrioid adenocarcinoma.Hysteroscopy is an effective method of evaluation and follow-up for these patients.Although there is no evidence that hysteroscopy-assisted endometrium extraction can improve the accuracy of pathological diagnosis,the combination of endometrial morphology under hysteroscopy and pathological diagnosis can reduce the rate of missed diagnosis of endometrioid adenocarcinomar,improving the coincidence rate of clinical diagnosis before and after surgery.So it is still a worthy evaluation method.Hysteroscopy before and after diagnostic curettage has no significant effect on the patient's preoperative clinical diagnosis,but hysteroscopy after the curettage has a risk of destroying the lesion and affecting the judgment of the examiner.For patients who only underwent diagnostic curettage before surgery and did not undergo hysteroscopy,it is still recommended to perform hysteroscopy after admission,and if necessary,take the endometrium again.For postmenopausal patients with endometrail atypical hyperplasia,the risk of endometrioid adenocarcinoma should be considered,which requires active management.When the pathological diagnosis of endometrium is endometrial hyperplasia and hysteroscopy is highly suspected of endometrial cancer,clinicians cancombine pelvic MRI,three-dimensional ultrasound,hysteroscopy NBI technology,tumor markers,intraoperative freezing intraoperative findings and other related diagnostic technology to make an accurate diagnosis.It is hoped that there will be more studies related to the differentiation of endometrial atypical hyperplasia and early endometrioid adenocarcinoma in the future to guide clinical work and reduce the missed diagnosis rate of early endometrioid adenocarcinoma.