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目的:探讨术前血清CA125测定联合术中膜式液基薄层细胞学技术(TCT)检测腹水/腹腔冲洗液细胞学诊断对子宫内膜癌分期的影响。方法:回顾性分析2003年6月~2007年6月收治的子宫内膜癌86例,检测患者术前血清CA125同时应用新柏氏薄层细胞学检测系统术中进行腹水细胞学检测,就术前临床分期与手术-病理分期进行比较,分析其对子宫内膜癌分期的影响及两者间关系,并对结果进行统计学分析。结果:①子宫内膜癌腹水瘤细胞阴性组中血清CA125均值为(42.8±19.6)U/m l;腹水瘤细胞阳性组中血清CA125均值为(125.7±38.1)U/m l;腹水瘤细胞阳性组血清CA125水平高于腹水瘤细胞阴性组,差异有统计学意义(P<0.05)。②TCT涂片观察细胞形态清楚,因腹水瘤细胞阳性而使26例临床Ⅰ期中2例上调到手术-病理分期的Ⅲa期,由于腹腔细胞学检查所致的分期变更率7.7%,Ⅱ期变更率17.9%(5/28)。③TCT检测腹水细胞阳性率与肿瘤期别关系密切,Ⅲ、Ⅳ期中腹水/腹腔冲洗液瘤细胞阳性率为40.6%(13/32),与Ⅰ、Ⅱ期瘤细胞阳性率12.9%(7/54)比较,差异有统计学意义(P<0.05)。结论:腹水细胞学检查对子宫内膜癌分期的影响值得关注,术中收集腹水/腹腔冲洗液送检是子宫内膜癌重要的诊断程序,应用TCT检测能够提高子宫内膜癌腹水瘤细胞分布的集中程度,提高瘤细胞诊断率;联合术前血清CA125测定对于准确分期并指导术后临床治疗及评估预后,具有重要的临床意义。
Objective: To investigate the effect of preoperative serum CA125 assay combined with intraoperative membrane liquid-based thin-layer cytology (TCT) on cytological diagnosis of endometrial carcinoma in ascites / peritoneal washings. Methods: A retrospective analysis of 86 cases of endometrial carcinoma admitted from June 2003 to June 2007 was performed. The serum CA125 was detected before operation. The ascites cytology was performed during the operation. Clinical staging and surgery - pathological staging were compared to analyze its impact on the staging of endometrial cancer and the relationship between the two, and the results were statistically analyzed. Results: ① The mean serum CA125 level in the ascites tumor-negative group was (42.8 ± 19.6) U / ml; the mean serum CA125 level in the ascites tumor-positive group was (125.7 ± 38.1) U / ml; the ascites tumor cell positive group The level of serum CA125 was higher than that of ascites tumor cells, the difference was statistically significant (P <0.05). ②TCT smear observation of cell morphology was clear, because of ascites tumor cells positive so that 26 cases of clinical stage Ⅰ in 2 cases up to surgery - pathological staging Ⅲa period, as a result of peritoneal cytology staging change rate of 7.7%, Ⅱ period change rate 17.9% (5/28). (3) The positive rate of TCT in detecting ascites cells was closely related to the tumor stage. The positive rate of ascites / peritoneal washings in stage Ⅲ and Ⅳ was 40.6% (13/32), which was significantly higher than that in stage Ⅰ and Ⅱ (12.9%, 7/54 ), The difference was statistically significant (P <0.05). Conclusion: The effect of ascites cytology on the staging of endometrial cancer is worthy of attention. Intraperitoneal ascites / peritoneal washings are an important diagnostic procedure for endometrial carcinoma. Using TCT detection can improve the distribution of ascites tumor cells in endometrial carcinoma The concentration of tumor cells to improve the diagnosis rate; combined preoperative serum CA125 determination for accurate staging and guidance of postoperative clinical evaluation and prognosis, has important clinical significance.