【摘要】 目的评价子宫内膜细胞学筛查子宫内膜癌的可行性和临床应用价值。方法选取162例有子宫内膜癌高危因素的患者,采用一次性手动式宫腔组织吸引管(YSZ-Ⅱ)采集细胞学标本,行诊断性刮宫或宫腔镜活检获取组织学标本。比较两种方法取材标本的满意率及诊断结果,评估子宫内膜细胞学筛查子宫内膜癌的灵敏度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、细胞学和组织学的诊断符合率,细胞学诊断不同类型子宫内膜癌的灵敏度。结果细胞学标本满意率为98.8%,高于组织学标本的92.6%,差异有统计学意义(P=0.014)。绝经后细胞学标本满意率为98.0%,高于组织学标本的90.0%,差异有统计学意义(P=0.037);绝经前细胞学和组织学标本满意率分别为100.0%和96.8%,两者比较差异无统计学意义(P=0.496)。细胞学筛查子宫内膜癌的灵敏度为0.79,特异度为0.89,阳性预测值为0.50,阴性预测值为0.97,假阳性率为0.12,假阴性率为0.21,诊断符合率为87.2%;筛查绝经后女性的灵敏度为0.71,特异度为0.91,阳性预测值为0.59,阴性预测值为0.94;筛查绝经前女性的灵敏度为1.00,特异度为0.86,阳性预测值为0.39,阴性预测值为1.00。细胞学筛查Ⅰ型子宫内膜癌(如子宫内膜样腺癌)的灵敏度为0.75,Ⅱ型子宫内膜癌(如子宫内膜透明细胞癌)的灵敏度为1.00。结论子宫内膜细胞学用于筛查子宫内膜癌具有一定的临床应用价值,对绝经后和Ⅱ型子宫内膜癌可能更具优势。更多还原

【Abstract】 Objective To evaluate the feasibility and clinical application of endometrial cytology screening for endometrial cancer.Methods One hundred and sixty two high risk patients undergoing screening for endometrial cancer were enrolled in the study. The disposable manual uterine cavity tissue suction tubes(YSZ-Ⅱ) were used to collect cytological specimen; then dilatation and curettage(D&C) or biopsy under hysteroscope were used to obtain histological specimens. The satisfaction and diagnostic results of both methods were compared.The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic coincidence rate of endometrial cytology in the screening of endometrial carcinoma were evaluated. Results The satisfactory rate of endometrial cytology was higher than that of histology(98.8% vs 92.6%, P=0.014); there was significant difference in postmenopausal women(98.0% vs 90.0%, P=0.037), but it had no difference in premenopausal women(100.0% vs 96.8%, P=0.496). For the endometrial cytology in diagnosis of endometrial cancer, the sensitivity, specificity,positive predictive value, negative predictive value and diagnostic accordance rate were 0.79, 0.89, 0.50, 0.97 and 87.2%, respectively. For postmenopausal women, the sensitivity, specificity, positive predictive value and negative predictive value were 0.71, 0.91, 0.59 and 0.94; those indicators for premenopausal women were 1.00, 0.86, 0.39 and 1.00, respectively. The sensitivity of cytological screening for type Ⅰ endometrial carcinoma(e.g. endometrioid adenocarcinoma) was 0.75, but that was 1.00 for type Ⅱ endometrial carcinoma(e.g. clear cell carcinoma). Conclusion Endometrial cytology in screening for endometrial cancer has certain clinical application value, particularly for postmenopausal women and type Ⅱ endometrial cancer.更多还原