Clinical Analysis Of The Diagnose Accordance Rate For Atypical Endometrial Hyperplasia Pre-and Post-Operation

OBJECT: Compared by analyzing the clinical pathological data of 77 patients with atypical endometrial hyperplasia(AEH) diagnosed from dilation and curettage specimens and underwent total hysterectomy in the short term, we explore its relationship with the postoperative diagnosis and evaluate the influence of preoperative diagnostic techniques in order to provide reference for choosing appropriate therapeutic means for the patients clinically diagnosed with AEH.Method: Between Oct. 2002 and Sep. 2008, at the Department of Gynecology of the First Affiliated Hospital of Guangxi Medical University, 77 patients subjected to total hysterectomy with a histological diagnosis of AEH were retrospectively selected. We collect the clinical data such as age, menopause, and whether infertility, complications, familial history of tumor, tumor marker, b-type ultrasound, operation methods, intra-operative exploration situation, postoperative pathology diagnosis, myometrial invasion, estrogen and progesterone receptors and so on. They were divided into two groups according to the postoperative pathological diagnosis of endometrial cancer(EC) and AEH, clinical data were compared between two groups to explore its relationship with the postoperative diagnosis.Results:1. 50 of 77 cases were diagnosed as EC,accounting for 64.9%, all for endometrial adenocarcinoma. That is, the risk of AEH associated with EC is 64.9%( the rate in this hospital and outside hospital is 56.9% and 80.8%). 27 cases were diagnosed as non-cancer.2. Compared with the age between the two groups, there was statistical significance (t=2.708,P=0.008<0.05). The peak age of incidence of EC and AEH were 50~59 years and 40~49 years, accounting for 50% and 44.4% respectively.3. Postoperative pathology diagnosis was correlated with pathological grade of AEH. The risk of AEH associated with EC increased with the pathological grades. The rate of mild, moderate and severe AEH associated with EC is 28.6%,42.1%,79.5%.4. With Chi-square test, there was no significant differences in serum tumor markers CA125 CA199 between the two groups (P>0.05).5. The value of frozen pathologic check in the judgment of EC: the sensitivity,specificity,positive predictive value,negative predictive value is 68.2%,100%,100%,58.8%, the total accuracy rate is 78.1%.Conclusion:1. The rate of concurrent endometrial carcinoma for AEH is 64.9%, most of them were well-differentiated,less-infiltrated and early-staged.2. Age is one of the risk factors for AEH associated with EC. Conservative treatment of patients more than 30 years old should be treated with caution.3. The risk of AEH associated with EC increased with the pathological grades increased. 4. Serum CA125 and CA199 is not the sensitive predictive index for AEH associated with EC or not.5. The value of intraoperative frozen pathologic check in the judgment of EC: the sensitivity and specificity were high, with a total accuracy rate higher, but there is still a certain partial of false-negative.