A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women
A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women
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DOI：
10.1016/j.fertnstert.2003.11.030
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发表时间：
2004-05-01
影响因子：
6.7
通讯作者：
Fritz, MA
中科院分区：
文献类型：
--
作者：
Murray, MJ;Meyer, WR;Fritz, MA
目的：完善或重新定义用于确定分泌期子宫内膜日期的传统组织学标准。
设计：随机观察性研究。
地点：学术临床研究中心。
患者：130名年龄在18至35岁之间的健康、月经周期规律且有生育能力的志愿者。
干预措施：在月经周期中期尿促黄体生成素高峰后的1至14天，患者被随机安排进行子宫内膜取样以及血清雌二醇和孕酮的测量。三名妇科组织病理学家对每个组织标本的32种不同组织学特征进行客观评分，并使用传统组织学标准确定子宫内膜日期。
主要观察指标：对32种特征进行以下评估：[1]随时间变化的差异，[2]在分泌期观察到的评分变化幅度，[3]观察者间的差异。此外，对传统的日期判定标准进行了分析。
结果：由于个体间、个体内以及观察者间存在相当大的差异，传统的子宫内膜组织学日期判定标准在时间上的区分度和鉴别力远不如最初描述的那样。无论是传统的日期判定标准，还是我们通过客观系统分析确定的表现最佳的组织学特征的任何组合，都无法可靠地区分任何特定的月经周期日或较窄的天数区间。
结论：组织学子宫内膜日期判定不具备为诊断黄体功能不全提供有效方法或指导生殖功能衰竭女性临床治疗所必需的准确性和精确性。
Objective: To refine or redefine the traditional histologic criteria used to date the secretory phase endometrium.Design: Randomized, observational study.Setting: Academic clinical research center.Patient(s): One hundred and thirty healthy, regularly cycling, fertile volunteers, aged 18 to 35 years.Intervention(s): Patients were randomized to undergo endometrial sampling and measurement of serum estradiol and progesterone I to 14 days after the midcycle urinary luteinizing hormone surge. Three gynecologic histopathologists objectively scored each tissue specimen for 32 distinct histologic features and dated the endometrium using traditional histologic criteria.Main Outcome Measure(s): The 32 features were evaluated for [1] temporally dependent variation, [2] the amplitude of variations in score observed across the secretory phase, and [3] interobserver variability. Additionally, traditional dating criteria were analyzed.Result(s): The traditional endometrial histologic dating criteria are much less temporally distinct and discriminating than originally described, due to considerable intersubject, intrasubject, and interobserver variability. Neither traditional dating criteria nor any combination of the best performing histologic features identified by our objective and systematic analyses could reliably distinguish any specific cycle day or narrow interval of days.Conclusion(s): Histologic endometrial dating does not have the accuracy or the precision necessary to provide a valid method for the diagnosis of luteal phase deficiency or to otherwise guide the clinical management of women with reproductive failure.