Descargues G, Lemercier E, David C, Genevois A, Lemoine J P, Marpeau L
Clinique Gynécologique et Obstétricale, Hôpital Charles-Nicolle, CHU Rouen.
J Gynecol Obstet Biol Reprod (Paris). 2001 Feb;30(1):59-64.
Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause. All patients underwent an hysterography and transvaginal sonohysterography, in random order, followed by an hysteroscopy with histological sample. The results were compared with the histo-pathological examination that was used for reference diagnosis. Statistical study of sensitivity, specificity and Positive and Negative Predictive Value (PPV-NPV) of each investigation; rate of agreement by the coefficient of Kappa.
The hysterography offers a PPV of 83% and a NPV of 100%. The interpretation errors were associated with the simple mucous hypertrophy interpreted as "hyperplasy". The limits correspond to a contrast agent allergy. The sonohysterography had a VPP of 89% and a VPN of 100%. The false positive is due to the difficulties of distinguishing the clots from the polyps. The limits correspond to the difficulties of cervix catheterization (13%). As regards the hysteroscopy, the VPP was 81.5% and the VPN of 75%. The interpretation mistakes were associated with mucous hypertrophy and the hyperplasy.
The most useful examination for abnormal uterine bleeding, in the first instance, is transvaginal sonography with saline instillation. A complement by Doppler study would probably make it possible to limit the false positives.
评估子宫输卵管造影、超声子宫输卵管造影及宫腔镜检查在异常子宫出血检查中的可行性及价值。方法。对38例绝经前后因异常子宫出血前来咨询的患者进行纵向盲法研究。所有患者随机顺序接受子宫输卵管造影和经阴道超声子宫输卵管造影，随后进行宫腔镜检查并取组织学样本。将结果与用于参考诊断的组织病理学检查进行比较。对每项检查的敏感性、特异性、阳性和阴性预测值（PPV-NPV）进行统计学研究；用Kappa系数计算一致性率。
子宫输卵管造影的PPV为83%，NPV为100%。解读错误与被解释为“增生”的单纯黏膜肥大有关。其局限性在于造影剂过敏。超声子宫输卵管造影的VPP为89%，VPN为100%。假阳性是由于难以区分血块和息肉。其局限性在于宫颈插管困难（13%）。至于宫腔镜检查，VPP为81.5%，VPN为75%。解读错误与黏膜肥大和增生有关。
对于异常子宫出血，首先最有用的检查是经阴道盐水灌注超声检查。多普勒研究作为补充可能有助于减少假阳性。
