The Clinical Analysis Of 93 Cases Of Early-stage Endometrial Carcinoma

Objective:This article analyzed the clinical datas of 93 cases of early-stage endometrial carcinoma,and explored the value of fractional curettage in this disease,meanwhile,it explored the relationships between different pathologic types,pathologic differentiation,depth of myometrial invasion,peritoneal cytology, levels of serum CA125,size of neoplasmas,and metastasis of the lymph nodes,it also compared different surgerys and explored their clinical significance.Method:The clinical datas of 93 patients of endometrial carcinoma were collected and retrospectively analyzed.All these patients were preoperatively or postoperatively diagnosed as stage-Ⅰor stage-Ⅱendometrial carcinoma and admitted to the department of Gynecology of first affiliated hospital of Dalian Medical University from Jan 2000 to March 2005.Results:1. The sensibility and specificity of fractional curettage was 91.3%and 96.74%,respectively. The coincidence rate of diagnosis for special pathologic types(not endometrioid adenocarcinoma) was 27.27%,lower than that of endometrioid adenocarcinoma(93.94%),P=0.000;and the coincidence rate of diagnosis for well differentiated cancer was (27.78%), lower than moderate or poor differentiated cancer(80%),P=0.016.2.The lymph node metastasis of endometrial carcinoma of stage-Ⅰwas related to special pathologic types,myometrial invasion≥1/2, pathologic differentiation worse than G2,serum CA125＞75/45U/ml (premenopause/ postmenopause),the biggest diameter of endometrial neoplasma≥4cm.The probability of lymph node metastasis in patients with these factors was bigger than in patients of endometrioid adenocarcinoma, myometrial invasion＜1/2,and differentiation less worse than G2,serum CA125≤75/45U/ml (premenopause/postmenopause),the biggest diameter of endometrial neoplasma＜4cm,respectively.Conclusion:1. Fractional curettage makes important sense in the diagnosis of endometrial carcinoma,but has limitation when it comes to special pathologic types,well differentiated and cancer staging.The coincidence rate is low.It suggusts that,doing hysterectomy first in the operation for the purpose to do frozen pathologic examination is very important.It is necessary to make sure whether high risks exit,so we can decide the type of operation(pelvic lymphadenectomy).2. Fractional curettage has some omissions in diagnosis,for the patients of atypical hyperplasia even vegetative state endometrium,we should take age,menopause or not,bleeding patterns and ultrasonic appearance of endometrium into account,and do hysteroscopy or hysterectomy when necessary.3. Special pathological types,endometrioid adenocarcinoma of G3, myometrial invasion≥1/2,serum CA125＞75/45U/ml (premenopause/ postmenopause),the biggest diameter of endometrial neoplasma≥4cm are high risks of pelvic lymph nodes metastasis.Dissection of pelvic and paraaortic lmyph nodes may be helpful for the diagnosis and prognosis of patients with high risk,especially for patients with 2 or more risks above.4. Extrafascial hysterectomy and bilateral salpingo-oophorectomy plus overall exploration is the standard surgery for early-stage endometrial carcinoma. Enlargement of the surgery(partly resection of para-uterine tissues and vagina) may not be helpful for stage-Ⅰendometrial carcinoma,especially for low-risk group.