| Background and Objective:Endometrial lesions are a group of pathological caused by endometrial changes,including endometrial hyperplasia,endometrial polyps,endometrial atypical hyperplasia and endometrial carcinoma.Endometrial carcinoma is a group of epithelial malignant tumors originating in the endometrium.Endometrial carcinoma is one of the most common malignant tumors in women,accounting for 7% of the female malignant tumor,20-30% of female genital tract malignancy.The main symptoms of endometrial carcinoma are irregular vaginal bleeding and vaginal discharge,especially in postmenopausal women.In recent years,along with the increase of people’s awareness of health care,diet and lifestyle changes,the aging population as well as factors of exogenous hormone abuse,the incidence of endometrial carcinoma is rising year by year,and tends to be younger.The traditional dilation&curettage as traditional diagnostic "gold standard",belongs to the invasive examination,with severity trauma for patients,not suitable for repeated operation,poor patient tolerance and compliance,so the screening is not suitable in the general population.With the increase of the incidence of endometrial carcinoma,clinicians urgently need a simplescreening method that have good patient tolerance and compliance,which can be applied to large-scale population screening methods,such endometrial carcinoma can be early detection,early diagnosis and early treatment,so as to improve the prognosis of patients and the quality of life.Therefore,one hundred and forty-six patients with hysteroscopic resection of endometrial polyp,subtotal hysterectomy and total hysterectomy in the China-Japan Union Hospital of Jilin University from September 2015 to November 2016 due to endometrial polyps,uterine fibroids,endometrial atypical hyperplasia and endometrial carcinoma were conducted.The patients tested for endometrial cytology in the preoperative,comparative analysis of the results of cytology and the results of postoperative pathological examination,and evaluating the clinical value and application prospect of ECT in screening of endometrial lesions.Methods:One hundred and forty-six patients with hysteroscopic resection of endometrial polyp,subtotal hysterectomy and total hysterectomy in the China-Japan Union Hospital of Jilin University from September 2015 to November 2016 due to endometrial polyps,uterine fibroids,endometrial atypical hyperplasia and endometrial carcinoma were conducted.The patients from the three aspects of menopausal status,the size of uterus,endometrial thickness were divided into three groups,including 101 casesof premenopausal patients,45 cases of postmenopausal patients;20 cases of uterus were greater than those of the patients with gestational age of 3months,126 cases of uterus were less than those of the patients with gestational age of 3 months;48 cases with endometrial thickness more than 1.2 cm,and 98 cases with less than 1.2 cm.Endometrial cells were collected from all patients before operation using SAP-I type endometrial cell collector in order to endometrial cytological test.The satisfactory standards in endometrial cells of Zhao as evaluation criteria,comparative analysis whether menopausal status,size of uterus,endometrial thickness were satisfaction affect SAP-I type endometrial cell collection.With postoperative pathological results as the "gold standard",comparative analysis shows that the sensitivity,specificity,positive predictive value and negative predictive value of ECT is used for screening of endometrial carcinoma.SPSS18.0 was used for statistical analysis.The enumeration data used χ2 test,and the significance judge standard was P<0.05.Results:1 Satisfaction of drawing materialThe satisfaction of drawing materials of using SAP-I type endometrial cell collector for endometrial cell collection was 94.52%(138/146).1.1 The effect of menopausal status on material satisfactionA total of 101 non-menopausal patients were selected,there are 96 patients were satisfaction of drawing materials.A total of 45 postmenopausal patients were selected,there are 42 patients were satisfaction of drawing materials.There was no significant difference in the effect of menopausal status on the satisfaction of drawing materials of SAP-I type endometrial cell collector(P > 0.05).1.2 The effect of uterine size on material satisfactionA total of 20 cases of uterus were greater than those of the patients with gestational age of 3 months,there are 5 patients were satisfaction of drawing materials.A total of 126 cases of uterus were less than those of the patients with gestational age of 3 months,there are 123 patients were satisfaction of drawing materials.The effect of uterine size on the satisfaction of drawing materials of SAP-I type endometrial cell collector was statistically significant difference(P < 0.05).1.3 The effect of endometrial thickness on material satisfactionA total of 48 patients with endometrial thickness more than 1.2cm were selected,there are 44 patients were satisfaction of drawing materials.A total of 98 patients with endometrial thickness less than 1.2cm were selected,there are 94 patients were satisfaction of drawing materials.There was no significant difference in the effect of endometrial thickness on the satisfaction of drawing materials of SAP-I type endometrial cell collector,(P > 0.05). 2 Compare the diagnosis of ECT with the postoperative pathological histologyIn 146 patients,the patients were not satisfied with the removal of the material in 8 cases,with postoperative histopathology results as the "gold standard" of diagnosis,comparative analysis cytological test results and postoperative pathological findings for 138 cases of patients were satisfied.Compared with the results of endometrial cytology and histopathology,the diagnostic accordance rate of ECT was 88.41%(122/138).The sensitivity,specificity,false negative rate,false positive rate,positive predictive value and negative predictive value of endometrial cytology test in screening of endometrial carcinoma were97.22%,95.10%,2.78%,95.10%,87.50% and 98.98% respectively.The sensitivity,specificity,false negative rate,false positive rate,positive predictive value and negative predictive value of endometrial cytology test in screening of endometrial benign lesions were 87.93%、96.25%、12.07%、3.75%、94.44%、91.67% respectively.Conclusion:1 It is proved that the method is feasible to use SAP-I type endometrial cell collector to collect endometrial cells,which has the advantages of simple operation,less pain and higher satisfaction.2 The satisfaction of endometrial cells collected by SAP-I type endometrial cell collector was not affected by menopausal status andendometrial thickness,but it is affected by the size of the uterus.3 Endometrial cytology has high diagnostic accordance rate,high sensitivity and specificity for the screening of endometrial lesions,and has the clinical value in the screening of endometrial lesions. |
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