宫腔镜辅助分段诊刮与单纯分段诊刮在早期子宫内膜癌分子病理诊断中的应用价值研究

Value of hysteroscopy-assisted fractional curettage and simple fractional curettage in molecular pathological diagnosis of early endometrial cancer

  • 摘要:
    背景 子宫内膜癌呈现年轻化趋势,越来越多初治育龄期妇女要求保留生育功能。随着宫腔镜的广泛运用和分子生物学技术的发展,分子诊疗逐渐在早期子宫内膜癌处置中成为优选方案。
    目的 分析早期子宫内膜癌患者宫腔镜诊刮活检与手术组织病理和分子表达的一致性,为早期微创治疗提供依据。
    方法 回顾性分析2020年6月— 2023年6月解放军总医院第一医学中心妇科收治的早期子宫内膜癌患者病历资料,比较宫腔镜辅助分段诊刮术组与单纯分段诊刮术组主要病理特征及分子病理的一致性,探讨分子诊断对保育方案的指导意义。
    结果 共纳入患者292例,中位年龄55(范围:32 ~ 76)岁。宫腔镜辅助分段诊刮术157例,单纯分段诊刮术135例。两组在年龄、体质量指数、合并症、绝经情况、产次、就诊主诉、FIGO分期、TCGA分子分型的差异均无统计学意义(P>0.05)。宫腔镜辅助分段诊刮术组病理诊断符合率高于单纯分段诊刮术组(75.16% vs 57.04%,P=0.001)。宫腔镜辅助分段诊刮术组诊断检出dMMR、p53abn对应符合MSI-H、CNH分型占比高于单纯分段诊刮术组,差异均有统计学意义(92.36% vs 82.96%,P=0.014;92.99% vs 84.44%,P=0.020)。宫腔镜辅助分段诊刮术组肿瘤分期手术前后Ki-67结果一致率高于单纯分段诊刮术组(24.20% vs 13.33%,P=0.019)。宫腔镜辅助分段诊刮术组128例肿瘤分期手术中留取腹腔冲洗液送细胞学检测,均未发现肿瘤细胞腹腔播散情况;两组患者均无子宫穿孔、出血和感染等并发症。5例保育患者经宫腔镜切除病灶联合口服高效孕激素治疗方案后,客观缓解率为100% (4例CR,1例PR),中位到达完全缓解的时间为3.7(范围:3.0 ~ 5.7)个月,此5例中3例怀孕后获得活产。
    结论 宫腔镜辅助分段诊刮技术可以提供更可靠的肿瘤分子特征,有助于推进子宫内膜癌的个体化诊疗。

     

    Abstract:
    Background Endometrial cancer shows a trend of rejuvenation. More and more women of reproductive age in initial treatment are requesting fertility preservation. With the widespread use of hysteroscopy and the development of molecular biology technology, molecular diagnosis and treatment have gradually become the preferred approach in the management of early endometrial cancer.
    Objective To analyze the consistency of histopathology and molecular expression between hysteroscopy-assisted segmental diagnostic scraping biopsy and surgical histopathology performed in patients with early-stage endometrial cancer, and provide references for early minimally invasive treatment.
    Methods Clinical data about patients with early endometrial cancer admitted to the Department of Gynecology of the First Medical Center of Chinese PLA General Hospital from June 2020 to June 2023 were retrospectively analyzed. The consistency of main pathological features was compared between hysteroscopy-assisted segmental diagnostic scraping group and segmental diagnostic curettage alone group.
    Results A total of 292 patients with a median age of 55 years (range: 32-76 years) were included. There were 157 cases undergoing hysteroscopy-assisted segmental curettage and 135 cases undergoing segmental curettage alone. There were no statistically significant differences in age, BMI, comorbidities, menopausal status, number of deliveries, complaints at the clinic, FIGO staging, and TCGA molecular typing between the two groups. The compliance rate of pathological diagnosis in the hysteroscopy-assisted diagnostic group was significantly higher than that of the segmental curettage alone group (75.16% vs 57.04%, P=0.001). In the hysteroscopy-assisted diagnosis group, dMMR and p53abn were detected in a higher percentage of MSI-H and CNH subtypes (92.36%, 92.99%) than in the segmental curettage group (82.96%, 84.44%), and the differences were significant (P=0.014, P=0.020). The percentage of consistent Ki-67 results before and after tumor staging surgery in patients with hysteroscopy-assisted segmental diagnostic scraping was significantly higher than that of segmental diagnostic scraping alone (24.20% vs 13.33%, P=0.019); the results of cytological testing of 128 cases of hysteroscopy-assisted segmental diagnostic scraping group with abdominal rinses taken during the tumor staging surgery showed that no tumor cells were found to have disseminated into the abdominal cavity. In addition, none of the 292 patients had complications such as uterine perforation, bleeding and infection. Five patients had an objective remission rate of 100% (four CR and one PR) after hysteroscopic resection of the lesions combined with an oral high-potency progesterone treatment regimen, with a median time to complete remission of 3.7 months (3-5.7 months), and 3 of the 5 cases had live births.
    Conclusion Hysteroscopy assisted curettage technology can provide more reliable molecular characteristics of tumor, which is helpful to promote the individualized diagnosis and treatment of endometrial cancer.

     

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