Clinical application of hysteroscopic"5+x"cold knife biopsy in the treatment of early endometrial carcinoma and atypical endometrial hyperplasia with fertility-sparing
Objective To explore a method for evaluating endometrial biopsy in patients with early endometrial cancer(EC)and atypical endometrial hyperplasia(AEH)in fertility sparing treatment.Methods Retrospective analysis of 71 patients with early-stage endometrial carcinoma and atypical endometrial hyperplasia who underwent primary treatment and regular evaluation in Peking University People's Hospital from July 2018 to March 2023 was performed.During the fertility-sparing treatment,the"5+x"cold knife biopsy under hysteroscopy were taken at 5 points of the uterine cavity(anterior wall,posterior wall,left lateral wall,right lateral wall,fundus)or curettage were used for evaluation and sampling.To evaluate the operation value of hysteroscopy"5+x"cold knife biopsy method by dynamically observing the condition and pathological changes of the uterine wall tissue during the fertility-sparing treatment.According to the evaluation method,they were divided into three groups:22 cases of hysteroscopic"5+x"cold knife biopsy(5+x group),16 cases of hysteroscopic curettage(D&C group),33 cases of hysteroscopic"5+x"cold knife biopsy+curettage(5+x combined D&C group).The clinical characteristics,fertility-sparing treatment and reproductive outcomes of the three groups were compared.Results ① Hysteroscopy"5+x"cold knife biopsy method in the fertility-sparing treatment ≤ 6 months,7-9 months,10-12 months,＞12 months;the number of samples taken from the 5 walls of the uterine cavity(including fundus,anterior,posterior,left and right uterine wall)was 4.9±0.4,4.8±0.4,4.7±0.7 and 4.8±0.6,respectively,and there was no significant difference among the groups(P＞0.05).The sampling failure rates of the five biopsy sites were 12.7％,21.4％,26.1％,20.0％,respectively,.There was no significant difference among all groups(P＞0.05).The sampling failure rates of the uterus fundus was 80％,which was higher than the other four walls.The number of samples from x site of uterine cavity was 1.4±0.7,1.5±0.6,1.3±0.6 and 1.0±0.0,respectively.The X-point lesions located in the left lateral wall accounted for 42.1％,and the right lateral wall accounted for 36.8％,which was higher than the other walls.The non-remission rates of lesions over 9 months treatment were 16.0％in anterior wall,24.0％in posterior wall,20.0％in left lateral wall,20.0％in right lateral wall and 20.0％in fundus wall.② The omission diagnostic rate in D&C group(12.5％)was higher than that in 5+x group(4.5％)and 5+x combined D&C group(3.0％),there was no significant difference between the groups(P＞0.05);The pregnancy rate of 5+x group(31.8％)was higher than that of D&C group(12.5％)and 5+x combined D&C group(15.2％),there was no statistical significant difference between the groups(P＞0.05).Conclusions Hysteroscopic"5+x"cold knife biopsy method has clinical operability as an evaluation system for the fertility-sparing treatment of early-stage EC and AEH,and can also treat uterine lesions＜5 mm in diameter,which has clinical application value.
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