The Value Of Intraoperative Rapid Pathological Examination In The Diagnosis Of Endometrial Carcinoma And Precancerous Lesion

Objective:Lots of patients with endometrial precancerouslesion after hysterectomy were diagnosed as endometrialmalignant tumor，which requires secondary surgery,whilecomplete staging surgery of patients with endometrialcancer requires to evaluate high risk factors todetermine the extent of surgery.In clinical working，inorder to reduce overtreatment and undertreatment of endo-metrial carcinoma and precancerous lesion,most gynecologists choose to make use of intraoperative rapid pathologicalexammination.In this article,through analysis of thedata of patients with preoperative diagnosis of endo-metrial cancer and precancerous lesions in the past5years to investigate the value of ntraoperative rapidpathological examination in the diagnosis of endometrialcarcinoma and precancerous lesion.Methods: Retrospectively analysis of the data of patientswith preoperative diagnosis of endometrial carcinoma andprecancerous lesions during2009.7-2014.9,who were under surgical treatment in the Department of Obstetrics and Gynecology, Second Affiliated Hospital of Jilin University,andall the relevant clinical and pathological data werestatistically recorded into Excel form, checking the ac-curacy of the data by the double output method.Accordingto postoperative pathology to investigate the missing diagnosis of canceration and endometrial cancer in the patientswith preoperative diagnosis of precancerous lesions,and an-alysis of the corrdance between intraoperative rapid pathological exammination and postoperative pathology in the cases who under intraoperative rapid pathological exammination.The patients with endometrial cancer are divided into rapidexamination group and non rapid pathological group ac-cording to whether through rapid pathologic examina-tion in operation or not, comparing the results of intra-operative rapid pathological examination and post-operative paraffin pathology in the patients with preoperative diagnosis of endometrial carcinoma,which is in the depth of myometrial invasion, histological grade and cervical involvement.Applicate SPSS19statistical softwarefor analysis and processing of the data to draw theconclusions. Results:1.The rate of patients with preoperative diagnosis ofuterine endometrial precancerous lesion missing diagnosisof canceration and endometrial carcinoma was49.2%.2.The coincidence rate of intraoperative rapid examinationand permanent sections was69.4%, the sensitivity and spe-cificity of the detection of canceration and endometrialcarcinoma of intraoperative rapid pathological is70%,97.7%, and negative predictive value (NPV) and positive predictive value (PPV) of78.6%,96.6%respectively.3.Comparing intraoperative rapid pathological results andpostoperative paraffin pathology in myometrial invasionof patients with endometrial carcinoma, the total coincidence rate was75.1%, and the coincidence rate of only mu-cosa invasion is95.9%,74.6%for＜1/2depth of myometrialinvasion,50.8%for≥1/2depth of myometrial invasion.4.Comparing intraoperative rapid pathological results andpostoperative paraffin pathology in histological grade ofpatients with endometrial carcinoma, the total coincidence rate was74.2%,94.3%for G1,59%for G2,and36%for G3.5.Comparing intraoperative rapid pathological results and postoperative paraffin pathology in cervical involvementof patients with endometrial carcinoma,the total coinci-dence rate was91.7%, coincidence rate of the not involved cervical cases is99.2%, while of the cervical involvedcases is39.5%.Conclusion:1.The preoperative pathological diagnosis of atypicalendometrial hyperplasia has a significant probability ofmissing diagnosis of canceration and endometrial carcinoma.2.Intraoperative rapid pathological examination can de-tect the canceration and endometrial carcinoma of pre-operative pathology of atypical endometrial hyperplasia,but the effect is confined.3.Intraoperative rapid exammination can evaluate the highrisk factors of endometrial carcinoma,comparing with thepostoperative pathology, the corrdance in myometrial inva-sion is significant,while the result of histological gradeis limited and of cervical invasion requires more improve-ment...