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Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature.
子宫内膜活检诊断的子宫内膜非典型增生的临床结局: 机构经验和文献综述。

摘要

The aims of this study were: (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); and (2) to determine the features of concurrent endometrial carcinoma and their impact on the subsequent management of AEH. We reviewed a retrospective series of 219 AEHs diagnosed locally in routine practice, over 24 years, and followed by a repeat biopsy or hysterectomy. Another series of 65 cases with a malignant diagnosis on preoperative sampling was included as a control group. Clinicopathologic parameters were obtained. In addition, published data on the risk of malignancy and features of malignant tumors after a diagnosis of AEH were collected and analyzed. This study reported on 2571 patients diagnosed in 31 published studies in addition to the current one. This showed a wide variation in the positive predictive value (PPV) of AEH in detecting endometrial cancer (6% to 63%) with an overall PPV of 37%. This variation is not only based on the differences among studies but also on the degree of atypia [mild/moderate (PPV 13%) or severe (PPV 50%)], the type of subsequent intervention (biopsy vs. hysterectomy), and more importantly the time period of diagnosis (around 20% in studies published before 1990s and up to 40% to 48% in recently published cases). Of the benign outcome cases, nearly 40% to 50% showed AEH with a potential risk of progressing to invasive carcinoma in 25% of cases. Malignant tumors after AEH diagnosis are associated with features of good prognosis with endometrioid morphology, lower grade, and early stage. Although the overall PPV of AEH is 37%, a figure of 40% to 48% is expected in the cases currently diagnosed in routine practice. Providing qualifying criteria for AEH will help identify its different associated risks and therefore should be included in routine pathology reports whenever possible. Unless there is a clinical contraindication, hysterectomy should be performed to treat concurrent carcinoma and to reduce the risk of subsequent carcinoma in nonmalignant cases with residual AEH.

译文

这项研究的目的是 :( 1) 回顾术前诊断为不典型子宫内膜增生 (AEH) 的患者并发子宫内膜癌的比率; 和 (2) 确定并发子宫内膜癌的特征及其对 AEH 后续管理的影响。我们回顾了超过 24 年在常规实践中本地诊断的 219 例 AEHs 的回顾性系列,随后进行了重复活检或子宫切除术。另纳入 65 例经术前取样诊断为恶性的病例作为对照组。获得临床病理参数。此外,收集并分析了诊断 AEH 后关于恶性肿瘤风险和恶性肿瘤特征的已发表数据。除了目前的研究,这项研究还报道了 31 项已发表研究中诊断的 2571 名患者。这表明在检测子宫内膜癌 (6% 到 63%) 时,AEH 的阳性预测值 (PPV) 有很大差异,总 PPV 为 37%。这种变化不仅基于研究之间的差异,也基于异型性的程度 [轻度/中度 (PPV 13%) 或重度 (PPV 50%)], 后续干预的类型 (活检 vs.子宫切除术),更重要的是诊断的时间段(在 1990年之前发表的研究中,约 20%,在最近发表的病例中,高达 40% 至 48%)。良好的结果,近 40% 至 50% 显示爱德华具有潜在危险的进展为浸润性癌占案例的 25%。AEH 诊断后的恶性肿瘤与预后良好的子宫内膜样形态、低级别和早期相关。尽管 AEH 的总 PPV 为 37%,但目前在常规实践中诊断的病例预计为 40% 至 48%。为 AEH 提供合格标准将有助于确定其不同的相关风险,因此应尽可能纳入常规病理报告。除非有临床禁忌症,否则应进行子宫切除术以治疗并发癌,并降低残留 AEH 的非恶性病例的后续癌的风险。

endometrial biopsy

妇产 子宫内膜病变 技术手段
概述  :  

子宫内膜活组织检查是一种医疗程序,涉及采集子宫内膜的组织样本,随后组织进行组织学评估。患有慢性无排卵的女性如多囊卵巢综合征患子宫内膜问题的风险增加,子宫内膜活检可能有助于评估其内层,以排除子宫内膜增生或癌症。鉴于子宫内膜活检可能有约10%的假阴性,如果高度怀疑子宫内膜癌或具有典型症状,子宫内膜活检阴性者,应在麻醉下再次分段诊刮、宫颈管搔刮,以减少漏诊。对有持续或者反复的未明确内膜病变的阴道流血者,宫腔镜辅助检查有助于判断子宫内膜病变的良恶性。子宫内膜活检并不能精确判断子宫内膜病变浸润深度,对

endometrial [ɛndʌ'mɛtrɪəl]

       adj. [解剖] 子宫内膜的

同根词   词根: endometrium

n.endometriosis [妇产] 子宫内膜异位  

endometrium [解剖] 子宫内膜

       Objective: To compare the curative effects between microwave endometrial ablation (MEA) and total hysterectomy for the treatment of menorrhagia. 目的:比较微波子宫内膜消除术(MEA)与经腹全子宫切除术治疗月经过多的疗效。

 

biopsy  英 ['baɪɒpsɪ]  美 ['baɪɑpsi]

       n. 活组织检查;活组织切片检查;切片检查法

       I think, in general, we biopsy less than before but I think that is also because we are making decisions around treatment. 我认为,总体上,我们做肝活检的次数比以前少了,但这也是因为我们是根据治疗情况做决定的

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