术前、术中病理预测早期子宫内膜样腺癌高危因素的效果评价

术前、术中病理预测早期子宫内膜样腺癌高危因素的效果评价目的评价术前病理、术中肉眼判断肌层浸润深度及冰冻切片病理预测临床Ⅰ期子宫内膜腺癌高危因素［子宫内膜样腺癌病理分级为G3和（或）肌层浸润深度≥1/2者］的准确性和一致性。

方法回顾性分析2000年1月~2010年6月在笔者所在医院妇科接受手术治疗的临床Ⅰ期子宫内膜腺癌102例患者的病理资料，以术后切除子宫病理诊断为“金标准”，评价预测高危因素的准确性和一致性。

结果术前病理分级预测高危因素的敏感度为66.7%，特异度为93.8%，阳性预测值为73.7%，阴性预测值为91.6%，Kappa值为0.63。

术中冷冻切片病理分级预测高危因素的敏感度为44.4%，特异度为91.4%，阳性预测值为61.5%，阴性预测值为84.1%，Kappa值为0.08。

术中肉眼判断肌层浸润深度评价的敏感度为66.7%，特异度为86.4%，阳性预测值为56.0%，阴性预测值为90.9%，Kappa 值为0.50。

术中冰冻切片判断肌层浸润深度的敏感度为76.5%，特异度为89.8%，阳性预测值为68.4%，阴性预测值为93.0%，Kappa值为0.63。

综合术前、术中病理预测高危因素的敏感度为79.4%，特异度为85.3%，阳性预测值为72.9%，阴性预测值为89.2%，Kappa值为0.63。

结论术前病理分级与冷冻切片相比有较高准确性，与术后病理有较高的一致性。

术中冷冻切片判断肌层浸润深度与术后病理有较高的一致性。

综合术前、术中病理预测与术后病理有较高的一致性，判断不需行腹膜后淋巴结切除的可靠性较高，但对需行腹膜后淋巴结切除的可靠性稍低，术前分级和冰冻切片判断肌层浸润深度结合可能提高预测的准确性。

标签：子宫内膜癌；诊断；肿瘤分期；肿瘤浸润Accuracy of preoperative and intraoperative pathological prediction in early endometrial adenocarcinoma SU Qing-hong，WANG Lan，GE Li-bin.The Seventh Affiliated Hospital of Guangxi Medical University，Wuzhou 543001，China【Abstract】Objective To evaluate the accuracy and consistency of preoperative pathological mechanism，intraoperative assessment of myometrial invasion depth through naked eyes，and prediction of the high risk factor of endometrioid adenocarcinoma clinical stage I through frozen section pathological mechanism(the grade of pathological mechanism of endomatrioid adenocarcinoma is G3 and myometrial invasion depth ≥1/2). Methods To analyze the pathological mechanism materials of those 102 endometrioid adenocarcinoma stage I patients who received operation in our hospital retrospectively，evaluate the accuracy and consistency of the prediction of the high risk factor during 2000，1 to 2010，6，taken the pathologic diagnosis of hysterectomization after operation as “golden standard”. Results The sensitivity of prediction of high risk factor of the grade of preoperative pathological mechanism was 66.7%，the specificity was 93.8%，the positivepredictive value was 73.7%，the negative predictive value was 91.6%，and Kappa value was 0.63.The sensitivity of prediction of high risk factor of the grade of intraoperative frozen section pathological mechanism was 44.4%，the specificity was 91.4%，the positive predictive value was 61.5%，the negative predictive value was 84.1%，and Kappa value was 0.08.The sensitivity of intraoperative assessment of myometrial invasion depth through naked eyes was 66.7%，the specificity was 86.4%，the positive predictive value was 56.0%，the negative predictive value was 90.9%，and Kappa value was 0.50.The sensitivity of intraoperative assessment of myometrial invasion depth of frozen section was 76.5%，the specificity was 89.8%，the positive predictive value was 68.4%，the negative predictive value was 93.0%，and Kappa value was 0.63.The sensitivity of prediction of high risk factor of preoperative，intraoperative pathological mechanism was 79.4%，the specificity was 85.3%，the positive predictive value was 72.9%，the negative predictive value was 89.2%，and Kappa value was 0.63. Conclusion The grade of preoperative pathological mechanism was more accurate than frozen section，and more consistency than pathological mechanism after operation，and intraoperative assessment of myometrial invasion depth of frozen section，prediction of high risk factor of preoperative，intraoperative pathological mechanism were more consistency.There was more reliability of assessment of unnecessary RPLND，but for the necessary RPLND the reliability is lower. The combination of the preoperation grade with the assessment of myometrial invasion depth of frozen section might promote the accuracy of prediction.【Key words】Endometrial neoplasms；Diagnosis；Neoplasms taging；Neoplasms invasiveness子宫内膜癌是女性常见的恶性肿瘤，随着人类寿命的延长和肥胖人群的增多，其发病率有持续上升的趋势。

子宫内膜癌的治疗趋于手术治疗为主的综合治疗。

本研究收集临床Ⅰ期子宫内膜癌的临床病理资料，评价术前分段诊刮或宫腔镜活检病理分级（术前分级），术中肉眼判断肌层浸润深度及冰冻切片预测是否存在高危因素的准确性和与术后病理的一致性，为决定手术范围提供依据。

1 资料与方法1.1 一般资料回顾性分析2000年1月~2010年6月在笔者所在医院妇科手术治疗有完整临床病理资料的临床Ⅰ期子宫内膜腺癌患者108例，年龄36~72岁，所有的患者均行筋膜外全子宫切除术+双附件切除术，术前、术中预测有高危因素者行腹膜后淋巴切除。

所有患者术前均未接受放疗、化疗或其他的抗肿瘤治疗，术后切除标本均送病理检查。

1.2 方法1.2.1 组织病理分级：术前分段诊刮或宫腔镜活检的子宫内膜组织和术中切除子宫标本均送病理检查。

依据FIGO推荐的组织学病理腺癌分级为：G1、G2、G3。

1.2.2 诊疗过程：患者术前行分段诊刮或宫腔镜活检取得子宫内膜病理分级（术前病理分级）。

基本手术方式是筋膜外全子宫切除术+双附件切除术，术中剖视子宫根据组织颜色和质地判断肌层浸润深度，部分切除子宫送冰冻切片获得病理分级及肌层浸润深度。

根据术前病理分级、术中肉眼判断肌层浸润深度和冰冻切片病理判断有无高危因素而决定是否行腹膜后淋巴结切除。

术后切除子宫标本均送病理检查，以术后病理为确诊标准。

1.2.3 高危因素判定标准：子宫内膜样腺癌病理分级G1~G2和肌层浸润深度＜1/2者为低危;子宫内膜样腺癌病理分级为G3和（或）肌层浸润深度≥1/2者为高危。

1.3 术前、术中预测子宫内膜样腺癌高危因素的准确性评价指标以术后切除子宫病理分级G3和（或）肌层浸润深度≥1/2者为“金标准”，术前、术中病理判断为高危，术后病理与以上两项中的一项相符为阳性，一项都不相符为假阳性；以术后切除子宫病理分级是G1~G2、肌层浸润深度＜1/2者为“金标准”，术前、术中判断为低危，术后病理与以上两项相符为阴性，术后病理与以上两项之一不相符者为假阴性。