Saline-Infusion Sonography Endometrial Sampling Compared With Endometrial Biopsy in Diagnosing Endometrial Pathology
Saline-Infusion Sonography Endometrial Sampling Compared With Endometrial Biopsy in Diagnosing Endometrial Pathology
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DOI：
10.1097/aog.0b013e31819b3fc7
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发表时间：
2009-04-01
影响因子：
7.2
通讯作者：
Twickler, Diane M.
中科院分区：
文献类型：
--
作者：
Moschos, Elysia;Ashfaq, Rahella;Twickler, Diane M.
目的：前瞻性评价在围绝经期和绝经后子宫异常出血的妇女中，与子宫内膜盲活检相比，盐水输注超声子宫内膜取样是否能提高子宫内膜良恶性疾病的诊断。方法：经初步评估和子宫内膜活检，40岁或以上的妇女异常子宫出血经阴道超声检查。对子宫内膜评估异常的患者行超声宫腔镜检查，并邀请其进入盐水输注超声子宫内膜取样研究。在超声宫腔镜检查结束时，在发现子宫内膜异常或子宫内膜腔正常的情况下，在子宫内膜腔的代表性部位使用子宫内膜取样刮匙进行盐水输注超声子宫内膜取样。将子宫内膜盲活检和子宫内膜盐水输注超声检查的组织病理学诊断与最终结果进行比较。计算两种采样技术的Kappa值以获得诊断准确性。结果：共获得子宫内膜盐水输注超声标本88例；80例获得最终结果。当比较盐水输注超声子宫内膜取样与最终结果时，盐水输注超声子宫内膜取样提供了89%的诊断时间（95%置信区间[CI] 82-95%），而子宫内膜活检提供了52%的诊断时间（95% CI 42-62%）。45例子宫内膜活检患者获得了最终结果。当比较子宫内膜活检与最终结果时，子宫内膜活检低估了病理的发生率，特别是当局灶性病变和恶性肿瘤存在时。差异有统计学意义(P
OBJECTIVE: To evaluate prospectively whether saline-infusion sonography endometrial sampling will improve diagnosis of benign and malignant endometrial disease compared with blind endometrial biopsy in perimenopausal and postmenopausal women with abnormal uterine bleeding.METHODS: After initial assessments and endometrial biopsies, women aged 40 or older with abnormal uterine bleeding were referred for transvaginal ultrasonography. Patients with abnormal endometrial evaluations were offered sonohysterography and invited to enter the saline-infusion sonography endometrial sampling study. Saline-infusion sonography endometrial sampling was performed at the end of sonohysterography using an endometrial sampling curette at the sight of the endometrial abnormality or at a representative site in the endometrial cavity if the cavity was normal. Histopathologic diagnoses of blind endometrial biopsy and saline-infusion sonography endometrial sampling were compared with final outcomes. Kappa values for the two sampling techniques were calculated for diagnostic accuracy.RESULTS: A total of 88 saline-infusion sonography endometrial samples were obtained; final outcomes were attained in 80 cases. When comparing saline-infusion sonography endometrial sampling with final outcomes, saline-infusion sonography endometrial sampling provided a diagnosis 89% of the time (95% confidence interval [CI] 82-95%) compared with endometrial biopsy at 52% (95% CI 42-62%). Forty-five patients with endometrial biopsies had final outcomes. When comparing endometrial biopsy with final outcomes, endometrial biopsy underestimated the incidence of pathology, especially when focal lesions and malignancy were present. This difference was statistically significant (P