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examination of endometrial cancer, diagnosis of endometrial cancer

examination of endometrial cancer, diagnosis of endometrial cancer

Common Examination of Endometrial Carcinoma

Check nameInspection siteInspection departmentCheck function
B-ultrasound of vaginaOvarian vaginaObstetrics and GynecologyPurpose of vaginal B ultrasound...
HCG semi-quantitativeUrineDepartment of Oncology Obstetrics and GynecologyHCG semi-quantitative analysis of early...
Examination items of reproductive system tumorsUterine testisReproductive healthTumors of the reproductive system...
Serum immunosuppressive acidic proteinBlood vesselTumorImmunosuppressive acid...
Cervical smear testFemale reproductive uterusDepartment of Gynecological Health CareCervical smear test...
Endometrial biopsyUterusGynecologyEndometrial biopsy...
Leucorrhea routineVaginaGynecologyRoutine examination of leucorrhea...
Serum carcinoembryonic antigenStomach, pancreas and lung--Continuous monitoring of carcinoembryos...
Pelvic CTPelvic cavity--Pelvic CT examination can...
MRIWhole bodyRadiological oncologyMRI...
HysterosalpingographyUterine fallopian tubeObstetrics and GynecologyHysterosalpingostomy...
Gynecological B-ultrasoundFemale reproductionGynecology【小于】 /i>Gynecological B-ultrasound...
Exfoliated cellUterus, ovary, esophagus and kidney--Exfoliated cell examination...
Serum tissue polypeptide antigenWhole body--Tissue polypeptide antigen...
P53 geneWhole body--This test is used for...
Multidrug resistance geneWhole body--Multidrug resistance (MDR...
Examination of endometrial carcinoma

1. Cytological examination

The positive rates of cervical smear, posterior vaginal fornix smear and cervical tube aspiration smear for cytological diagnosis of endometrial carcinoma were not high, which were 50%, 65% and 75% respectively. Cervical stenosis in elderly women makes it difficult for endometrial exfoliated cells to exclude cervix, and it is easy to dissolve and degenerate. In recent years, new progress has been made in cytological sampling methods, such as endometrial flushing, nylon mesh endometrial scraping and uterine cavity suction smear, etc. The accuracy rate of the latter can reach 90%, but the operation is complicated, and positive results only have the function of screening examination, which can not be used as the basis for diagnosis, so the application value of clinical examination is limited.

2. Histopathological examination

Histopathological examination of endometrium is the basis for the diagnosis of endometrial carcinoma, and it is also the only method to understand the pathological type and cell differentiation degree. Tissue specimen taking is an important problem affecting the accuracy of histopathological examination. Commonly used endometrial specimens are taken:

Endometrial biopsy;

Curettage of cervical canal;

③ Segmental diagnosis and curettage. Segmental diagnosis and curettage is the most common and valuable method. After disinfecting the bedding, first scrape the cervical tube with a cervical curette to take the cervical tube tissue; Then use the probe to detect the depth of the uterine cavity, and finally scratch the uterine cavity completely. All tissues scraped out of cervical canal and uterine cavity should be fixed and sent for histopathological examination. The advantage of segmental curettage is that it can distinguish endometrial carcinoma from cervical adenocarcinoma, and can also determine whether endometrial carcinoma involves cervical canal, assist clinical staging (stage I and stage II), and provide basis for the formulation of treatment plan. Clinicians should pay attention to strictly abide by the surgical procedures to avoid scraping leakage and mixing in cervical canal and uterine cavity. In assisting staging, it is difficult to diagnose whether cervical cancer is involved or not by scraping specimens of endometrial cancer. The clinical examination level and experience of pathologists in obstetrics and gynecology will affect the accuracy of segmented diagnosis to a certain extentSex. Some domestic scholars reported that 69 cases of endometrial carcinoma were diagnosed by segmental pathological specimens compared with postoperative hysterectomy specimens. The false positive rate was 34.5%, and the false negative rate was 12.68% (the total error rate was 47.2%). For those with obvious lesions in the uterine cavity, uterine biopsy (suction and curettage) and cervical tube curettage are the simplest and feasible outpatients.

1.) Hysteroscopy

At present, hysteroscopy has been widely used in the diagnosis of endometrial lesions, and fiberoptic hysteroscopy is the most widely used in China. About 20% of postmenopausal patients with vaginal bleeding are endometrial carcinoma. Hysteroscopy can directly observe the cervical canal and uterine cavity, find the lesion and take biopsy accurately, which can improve the diagnosis rate of biopsy, avoid the missed diagnosis by routine diagnosis and curettage, and provide information such as the scope of lesion and whether the cervical canal is involved, so as to assist the correct clinical staging before operation. However, due to hysteroscopy, uterine swelling fluid should be injected, which may flow into pelvic cavity through fallopian tubes, resulting in cancer cell proliferation and affecting prognosis, which should be paid attention to.

2.) Cystoscopy and rectoscopy

It is of great significance to whether there is tumor invasion, but it should be confirmed by biopsy before it can be diagnosed as bladder or rectal involvement.

3.) Lymphography, computed tomography (CT) and magnetic resonance imaging (MRI)

Lymphatic metastasis is the main spreading route of endometrial carcinoma. The lymphatic metastasis rate of stage I endometrial carcinoma was 10.6% and stage II endometrial carcinoma was 36.5%. Lymphangiography can be used to predict lymph node metastasis before operation, but it is complicated to operate and difficult to puncture, so it is difficult to popularize and apply clinically. Since the application of FIG0 new surgical-pathological staging in 1989, the lymph node metastasis can be determined by surgical and pathological examination, and the prognosis can be accurately judged. The selection range of lymphography has been smaller than before. CT and MRI are mainly used to understand the lesions of uterine cavity and cervix, the depth of myometrial invasion, whether lymph nodes grow up (more than 2cm), etc. Because of their high cost, they have not been used as routine examinations. At present, MRI is considered to be of great value in providing myometrial infiltration and retroperitoneal lymph node metastasis from imaging, which can be used to guide treatment (FIGO, 2003).

4) B-mode ultrasound examination

In recent years, B-mode ultrasonography has developed rapidly, especially transvaginal B-mode ultrasonography has been widely used in gynecological clinic (TVB), and has made some progress in auxiliary diagnosis of endometrial lesions. Transvaginal ultrasonography can be used to understand the size of uterus, the shape of uterine cavity, whether there is neoplasm in uterine cavity, the thickness of endometrium, whether there is infiltration and depth of myometrium (Sahakian, 1991), which provides reference for clinical diagnosis and pathological sampling (uterine biopsy or curettage). Uterine bleeding in postmenopausal women can be further diagnosed according to the results of transvaginal B-ultrasound.

According to reports from domestic and foreign scholars, the average thickness of atrophic endometrium in postmenopausal women measured by vagina is 3.4 mm 1.2 mm, and that of endometrial cancer is 18.2 mm 6.2 mm. It is considered that if the endometrial thickness of postmenopausal bleeding patients is less than 5mm by vaginal B-ultrasound, diagnostic curettage may not be performed. Hysteroscopic biopsy can be used if local small neoplasm is determined by B-ultrasound examination. If there are a large number of neoplasm in uterine cavity, the boundary of endometrium is unclear and incomplete, or the muscular layer is obviously thinned or deformed, simple endometrial biopsy is appropriate.

A large number of clinical studies in recent 10 years have shown that the previous view that endometrial cancer is simple and easy to treat is wrong. If compared by stages, endometrial cancer is as refractory as ovarian cancer in the same period, and it also needs rigorous and unified standardized treatment by gynecological oncologists. At present, there is no effective screening method except hysteroscopy or biopsy for high-risk groups such as Lynch II syndrome patients, which is helpful for early diagnosis. Karlsson et al. (1995) reported that the results of transvaginal B-mode ultrasound examination in 1168 women were compared with those of curettage and endometrial biopsy. The endometrial thickness was 5mm as the threshold, and the vaginal prediction was 96%, the positive predictive value was 87%, and the sensitivity was 100%. Moreover, it has the advantages of non-invasive and simple, and has been widely used.

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guidelines for Treatment of Endometrial Carcinoma-Endometrial Carcinoma



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