A Study On The High Risk Factors Of Endometrial Atypical Hyperplasia Patients With Postoperative Endometrial Cancer

Objective:Retrospective analysed the clinical data of 91 patients with preoperative diagnosis of endometrial atypical hyperplasia,Predict the high risk factors of preoperative endometrial atypical hyperplasia with postoperative endometrial cancer.Methods:From January 1,2007 to December 31,2016,at the Second Affiliated Hospital of Dalian Medical University,91 cases subjected to total hysterectomy with a histological diagnosis of endometrial atypical hyperplasia by diagnostic curettage or hysteroscopy fixed-point biopsy were retrospectively selected.Divided all the cases into two groups according to the postoperative paraffin pathology : endometrial atypical hyperplasia(65 cases)and endometrial carcinoma(26 cases).After that,we explored the high risk factors of endometrial atypical hyperplasia patients with postoperative endometrial cancer by comparing the factors such as age,menopausal status,height and weight,reproductive history,complications(high blood pressure or diabetes),malignant tumors history,family history of cancer,clinical manifestation,course of disease,the indexing of preoperative endometrial atypical hyperplasia,tumor markers(serum CA125),endometrial thickness and blood flow presented by ultrasound Before the endometrium is drawn.ResuIts:1.Based on postoperative pathological results,Divided 91 endometrial atypical hyperplasia cases into two groups:endometrial atypical hyperplasia(non-EC)and endometrial carcinoma(EC),non-EC are 65 cases(71.43%)and EC are 26cases(28.57%).All the endometrial cancer is adenocarcinoma.High(G1),medium(G2)and low(G3)differentiated occupies 73.08%(19 cases),23.08%(6 cases),3.85%(1 cases).Ia,Ib,II occupies 76.92%(20 cases),15.38%(4 cases),7.69%(2 cases)separately in 26 EC cases.Cancers limited in endometrium are 9 cases(34.62%)and muscular infiltrated(<1/2 muscular layer)are 11 cases(42.31%).2.The accuracy rate of diagnosising endometrial atypical hyperplasia by diagnostic curettage was 70.00%;missed diagnostic rate of endometrial carcinoma was30.00 %.The accuracy rate of diagnosising endometrial atypical hyperplasia by hysteroscopy fixed-point biopsy was 76.19 %;missed diagnostic rate of endometrial carcinoma was 23.81%.There was no obvious statistical significance difference for the accuracy rate of diagnosising endometrial atypical hyperplasia and missed diagnostic rate of endometrial carcinoma between diagnostic curettage and hysteroscopy.3.The results of intraoperative frozen pathology in the judgment of EC : the sensitivity?specificity,positive predictive value,negative predictive value is 62.50%?70.59%?66.67%?66.67%,the total accuracy rate is 66.67%.4.The single factor analysis : menopausal status,BMI?28kg/m~2,course of disease,the indexing of preoperative endometrial atypical hyperplasia,endometrial thickeness and blood flow ultrasonic tips were statistically significant;Only BMI?28kg/m~2,the indexing of preoperative endometrial atypical hyperplasia and rich blood flow ultrasonic tips were the high risk factors of endometrial atypical hyperplasia with postoperative endometrial cancer after multivariable Logistic regression analysis.Conclusion:1.The incidence of endometrial atypical hyperplasia patients with endometrial cancer after hysterectomy was 28.57%.Most of the cases which diagnosed as EC by postoperative paraffin pathology were early-staged and well-differentiated adenocarcinoma.2.The missed diagnostic rate of endometrial carcinoma by diagnostic curettage and hysteroscopy fixed-point biopsy was 30.00 % and 23.81%.The accuracy rate of intraoperative frozen pathology in the judgment of EC is 66.67%.Do other auxiliary examination to improve the diagnostic accuracy when it is necessary.3.Obesity(BMI?28kg/m~2),the indexing of preoperative endometrial atypicalhyperplasia and rich blood flow ultrasonic tips were the high risk factors of endometrial atypical hyperplasia with postoperative endometrial cancer.