Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis
Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis
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DOI：
10.1002/uog.20274
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发表时间：
2019-10-01
影响因子：
7.1
通讯作者：
Jurkovic, D.
中科院分区：
文献类型：
--
作者：
Dooley, W. M.;Chaggar, P.;Jurkovic, D.
目的评价经阴道超声（TVS）对经手术治疗的大量妇女各种类型宫外异位妊娠（EUEP）诊断的总体准确性。我们还旨在评估TVS对EUEP不同超声形态类型的阳性预测值（PPV）。方法回顾性观察研究，纳入2009年1月至2017年12月间在单个早孕期单位超声诊断为EUEP后接受急诊手术的所有孕妇。记录术前TVS的表现，包括EUEP的确切位置和形态类型（I-V型；用超声标准定义）。比较TVS的手术表现和组织学表现。以术中异位妊娠的视觉确认为参考标准，评估超声对EUEP的整体诊断和形态分型的诊断效果。结果在研究期间，共有26401名妇女出现妊娠早期并发症，其中1241名（4.7%;95% CI, 4.5-5.0%）妇女在TVS上确诊为EUEP或基于严重疼痛和明显腹膜出血的推定诊断。721/1241例（58.1%,95% CI, 55.3-60.8%）患者行手术治疗，其中710例（98.5%,95% CI, 97.6-99.4%）患者术前TVS确诊为EUEP。其余11名妇女有严重的疼痛和明显的腹膜积血，在超声检查未发现异位妊娠的情况下，作为临床紧急情况进行了手术处理。在腹腔镜检查中，超声诊断阳性的女性中有706/710 （99.4%;95% CI, 98.6-99.8%）确诊为EUEP，所有11名女性均推定超声诊断为EUEP。术前超声诊断EUEP的PPV为99.4% (95% CI, 98.6-99.8%)，敏感性为98.5% （95% CI, 973 -99.1%）。5种形态类型术前超声诊断准确率比较，差异无统计学意义（P=0.76）。结论术前超声诊断EUEP准确率高。TVS上EUEP的形态类型对术前诊断的准确性无显著影响。版权所有2019 ISUOG由John Wiley & Sons Ltd出版。
Objectives To assess the overall accuracy of transvaginal ultrasound (TVS) for diagnosis of all types of extrauterine ectopic pregnancy (EUEP) in a large group of women who were managed surgically. We also aimed to assess the positive predictive value (PPV) of TVS for each of the different ultrasound morphological types of EUEP.Methods This was a retrospective observational study of all pregnant women who underwent emergency surgery following ultrasound diagnosis of EUEP at a single early pregnancy unit between January 2009 and December 2017. The preoperative TVS findings were recorded, including the exact location and morphological type (Type I-V; defined using ultrasound criteria) of EUEP. TVS findings were compared with operative and histological findings. The performance of ultrasound in diagnosing EUEP overall and according to morphological type was assessed, using visual confirmation of ectopic pregnancy at surgery as the reference standard.Results A total of 26 401 women presented with early-pregnancy complications during the study period, including 1241 (4.7%; 95% CI, 4.5-5.0%) women with a conclusive diagnosis of EUEP on TVS or a presumed diagnosis based on severe pain and significant hemoperitoneum. Surgery was performed in 721/1241 (58.1%; 95% CI, 55.3-60.8%) cases, of which 710 (98.5%; 95% CI, 97.6-99.4%) had a conclusive diagnosis of EUEP on preoperative TVS. The remaining 11 women had severe pain and significant hemoperitoneum and were managed surgically on clinical grounds as an emergency, without an ectopic pregnancy having been identified on ultrasound examination. At laparoscopy, the diagnosis of EUEP was confirmed in 706/710 (99.4%; 95% CI, 98.6-99.8%) women with a positive ultrasound diagnosis and in all 11 women with a presumed ultrasound diagnosis of EUEP. The PPV of preoperative ultrasound for the diagnosis of EUEP was 99.4% (95% CI, 98.6-99.8%) with sensitivity of 98.5% (95% CI, 97.3-99.1%). There was no statistically significant difference in the accuracy of preoperative ultrasound diagnosis between the five morphological types (P=0.76).Conclusions The accuracy of preoperative ultrasound for diagnosis of EUEP is high. The morphological type of EUEP on TVS had no significant effect on the accuracy of preoperative diagnosis. Copyright (C) 2019 ISUOG. Published by John Wiley & Sons Ltd.