日本語AIでPubMedを検索
非定型子宮内膜過形成と最終組織診での予期せぬ癌．子宮内膜のサンプリング方法とリスク因子に関する研究
Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors.
PMID: 32668563 DOI: 10.3390/diagnostics10070474.
抄録
背景:
BACKGROUND: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC.
方法:
METHODS: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient's characteristics were compared between the three ESM groups.
結果:
D&C と HSC-bio は各群 75 例，HSC-res は 58 例であった．子宮摘出時にがんが判明した女性は49人（23.6％）であった（テスト前確率）。試験後の確率解析では、HSC-resはEC過小評価の割合が最も低かった。HSC-res＝11.6％、HSC-bio＝19.5％、D&C＝35.3％であった。患者特性は3つのESM間で有意差は認められなかった。多変量解析では、体格指数≧40（オッズ比（OR）＝19.75）であった。
RESULTS: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193-177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002-1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%.
結論:
また，造血幹細胞抵抗体は AEH における心電図過小評価率が最も低く，心電図予測因子を示した女性においても，心電図過小評価率が最も低かった．これらのデータは，AEHの診断と治療計画の改善のために検討される可能性がある．
CONCLUSIONS: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.