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目的分析漏诊子宫内膜癌(EC)患者15例的相关特征。方法经诊刮或宫腔镜手术病理诊断为子宫内膜不典型增生(AEH)患者62例接受了全子宫切除术。手术后15例病理证实为EC。回顾性分析患者术前彩超、MRI数据及术后免疫组化检查资料。结果 28例宫腔镜取材诊断为AEH,术后3例(10.71%)病理诊断EC;34例诊刮取材诊断为AEH,12例(35.29%)术后病理诊断EC(P<0.05)。术前阴道彩超显示,EC漏诊15例的子宫内膜厚度(19.40±3.89)mm,大于47例AEH患者的(12.83±4.30)mm(P<0.01)。AEH与EC患者中彩超测高阻力动脉血流及低阻力动脉血流比例有统计学差异(P<0.05)。15例EC患者MRI在磁共振弥散加权成像(DWI)上呈高信号,表观扩散系数(ADC)值为(0.87±0.19)×10~(-3) mm~2/s,47例AEH患者MRI在DWI上呈略高信号,ADC值为(1.14±0.39)×10~(-3) mm~2/s(P<0.01)。术后免疫组化结果显示,EC患者同源框基因A10(HOXA10)表达水平低于AEH患者(P<0.05)。结论分析AEH患者术前阴道彩超和MRI的DWI信号对鉴别AEH和EC有一定的参考价值。
Objective To analyze the related features of 15 patients with missed diagnosis of endometrial carcinoma (EC). Methods Totally 62 cases of endometrial dysplasia (AEH) diagnosed by curettage or hysteroscopic surgery underwent total hysterectomy. Fifteen cases were pathologically confirmed as EC after surgery. Retrospective analysis of patients with preoperative ultrasound, MRI data and postoperative immunohistochemical data. Results 28 cases were diagnosed by hysteroscopy as AEH, and 3 cases (10.71%) were pathologically diagnosed as EC. 34 cases were diagnosed as AEH by curettage and 12 cases (35.29%) were pathologically diagnosed by pathology. Preoperative vaginal ultrasonography showed that the endometrial thickness in 15 cases missed by EC was (19.40 ± 3.89) mm, and was significantly higher than that in 47 cases with AEH (12.83 ± 4.30) mm (P <0.01). There was a significant difference in the ratio of color Doppler ultrasound resistance blood flow and low resistance arterial blood flow between AEH and EC patients (P <0.05). The MRI of 15 patients with EC showed high signal intensity on diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) was (0.87 ± 0.19) × 10 -3 mm 2 / s in 47 patients with AEH MRI showed a slightly higher signal on DWI with an ADC value of (1.14 ± 0.39) × 10 ~ (-3) mm ~ 2 / s (P <0.01). Postoperative immunohistochemical results showed that the expression of HOXA10 gene was lower in EC patients than in AEH patients (P <0.05). Conclusions Analysis of DWI signals of preoperative vaginal ultrasound and MRI in AEH patients is of certain reference value in differentiating AEH and EC.