Value Of Fractional Curettage Of Prehysterectomy In Atypical Endometrial Hyperplasia And Analysis Of Related Factors

Objective:Compared by analyzing the clinical data and surgical pathology of patients with atypical endometrial hyperplasia(AEH) diagno-sed from dilation and curettage specimens, we evaluate the value of fractional curettage and predict the endometrial cancer(EC)high risk factors.Method:We collect the clinical data of 45 patients subject to surgery with atypical endometrial hyperplasia at the department of obstetrics and gynecology of the First Affiliated Hospital of Dalian Medical University from January 2001 to June 2009, and compare curettage pathology results with surgical pathology results. Patients were divided into two groups according to the surgery pathological diagnosis of endometrial cancer and non-endometrial cancer, clinical data were compared between two groups to predict high risk factors with the postoperative diagnosis.Result:1,The risk of AEH associated with EC increased with pathological grade of AEH. The rate of mild, moderate and severe AEH associated with EC is 12.5%,20%and 83.3%.2,12 of 45 cases were diagnosed as AEH, accounting for 26.7%,10 cases (22.2%)were diagnosed as neither AEH or EC through postoperative pathology, and 23 cases(51.1%) were diagnosed as EC.3,Among the 23 patients with final diagnosis of EC, myometrial invasion was present in 78.2%of cases:the invasion was superficial in 88.9%and deep in 11.1%. In the remaining 21.8%of cases, cancer was confined to the endometrium. The tumor was well differentiated in 16 cases and moderately differentiated in 6 and poorly differentiated in 1.4,There was no significant difference among the two group in patient's age, parity, height, weight, BMI, menopausal status, hypertension, diabetes, CA125 values and ultrasound to predicting high risk factors of AEH degenerating into EC. The average age of endometrial cancer group is 52.5, and the average of non-endometrial cancer group is 48.0. Among three parameters such menopausal status, hypertension, diabetes, the endometrial cancer group is obviously higher than non-endometrial cancer group, respectively account for 47.8%,31.8%,30.4%,13.6%,13.0%,0%.Conclusion:1,The diagnose accordance rate of fractional curettage is 26.7%,and we need thysteroscopy biopsy to improve diagnostic accuracy.2,Endometrial cancer after surgery was upgraded to 51.1%.The risk of AEH associated with EC increased by the pathological grades.3,Most of EC were well-differentiated, less-infiltrated and early-staged.4,Patients with older age, menopause, hypertension and diabetes diagnosed as AEH through curettage should be given sufficient attention.5,Hysterectomy is still the best treatment for patients diagnosed as atypical hyperplasia, if they are willing to give up their fertility. In order to improve diagnostic accuracy, clinical parameters, fractional curettage, intraoperative frozen pathology and genetic level and protein level should be taken into account.