Analysis The High Risk Factors Of Endometrial Atypical Hyperplasia Patients With Postoperative Pathologic Upgrade

Objective: Retrospective analysed the clinical data of98patients withendometrial atypical hyperplasia(EAH), evaluate the diagnostic value ofdiagnostic curettage, hysteroscopy fixed-point biopsy and intraoperativefrozen pathology; analyze the misdiagnostic reasons; explore the high riskfactors which can predict EAH upgrade.Materials and methods: From January1,2003to December31,2013,at the Department of Gynaecology of the First Affiliated Hospital of DalianMedical University,98cases subjected to total hysterectomy with ahistological diagnosis of EAH by diagnostic curettage or hysteroscopyfixed-point biopsy were retrospectively selected. Assess the value ofdiagnostic curettage、hysteroscopy fixed-point biopsy and intraoperativefrozen pathological in the diagnosis of EAH through the analysis of thepreoperative, intraoperative frozen and postoperative paraffin pathologicresults. Divided all the cases into two groups according to the postoperativeparaffin pathology: endometrial carcinoma(EC) and non-EC.After that,weexplored the high risk factors which can predict EAH upgrade by comparingthe factors such as age, menopausal status, body mass index, reproductivehistory, complications (high blood pressure, diabetes or other malignant tumors history), clinical manifestation, tumor markers (serum CA125),endometrial thickness and blood flow presented by ultrasound.Statistical method: Using SPSSl7.0statistical software for dataanalysis, P <0.05was statistically significant.Results:1.61of98EAH cases(62.24%) were still confirmed for EAH bypostoperative paraffin pathology; the other cases (37.76%)were diagnosedas EC,36cases of which as endometrial adenocarcinoma,1case mergedsquamous cell carcinomas. Ia, Ib, II, III occupies81.08%(30/37),5.41%(2/37),5.41%(2/37),8.11%(3/37) separately in37EC cases, includinghigh,medium and low differentiated ones72.97%(27/37),21.62%(8/37),5.41%(2/37) respectively.2. The postoperative paraffin section of the pathological diagnosis wascorrelated with grade of EAH. The rate of EAH upgraded for EC increasedwith the pathological grades. The rate of mild，moderate and severe EAHassociated with EC is11.76%(2/17),10.53%(4/38),80%(28/35).3. Preoperative and postoperative pathological coincidence rate ofdiagnostic curettage and fixed-point biopsy was61.84%(47/76),63.64%(14/22) separately; missed diagnostic rate of endometrial carcinoma was38.16%(29/76),36.36%(8/22) respectively.4.The value of intraoperative frozen pathology in the judgment of EC：the sensitivity、specificity、positive predictive value、negative predictive value is63.64％、65％、66.67％、61.9％，the total accuracy rate is64.29％.Missed diagnostic rate of intraoperative frozen pathology was36.36%.5. The single factor analysis: obesity, menopause,endometrialthickeness and blood flow as the prediction of EAH cases upgraded to ECwas statistically significant; Only obesity and rich blood flow ultrasonictips were statistically significant after multivariable Logistic regressionanalysis.Conclusion:1. Most of the cases which diagnosed as EC by postoperative paraffinpathology were early-staged and well-differentiated adenocarcinoma;2.The rate of EAH upgraded for EC increased with the pathologicalgrades increased;3. There were some false negatives in the diagnosis of EC bydiagnostic curettage、hysteroscopy fixed-point biopsy and intraoperativefrozen pathological, need to be careful treated;4. EAH patients associated with obesity, if the endometrial blood flowultrasonic tips were rich, should be highly alerted to EC.