Clark T Justin, Voit Doris, Gupta Janesh K, Hyde Christopher, Song Fujian, Khan Khalid S
Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham B15 2TG, England.
JAMA. 2002 Oct 2;288(13):1610-21. doi: 10.1001/jama.288.13.1610.
Hysteroscopy (direct endoscopic visualization of the endometrial cavity) is used extensively in the evaluation of common gynecologic problems, such as menorrhagia and postmenopausal bleeding. However, there is a continuing debate about the value of this technology in the diagnosis of serious endometrial disease.
To determine the accuracy of hysteroscopy in diagnosing endometrial cancer and hyperplasia in women with abnormal uterine bleeding.
Relevant articles were identified through searches of the Cochrane Library, MEDLINE, and EMBASE (1984-2001), manual searches of bibliographies of known primary and review articles, and contact with manufacturers.
Studies were selected blindly, independently, and in duplicate if accuracy of hysteroscopy was estimated in women with abnormal uterine bleeding, using histopathologic findings as a reference standard. Our search identified 3486 articles; 208 of these were deemed to be potentially eligible and were retrieved for detailed data extraction. Sixty-five primary studies were analyzed, including 26 346 women.
Data were abstracted on characteristics and quality from each study. Results for diagnostic accuracy were extracted to form 2 x 2 contingency tables separately for endometrial cancer and endometrial disease (cancer, hyperplasia, or both). Pooled likelihood ratios (LRs) were used as summary accuracy measures.
The pretest probability of endometrial cancer was 3.9% (95% confidence interval [CI], 3.7%-4.2%). A positive hysteroscopy result (pooled LR, 60.9; 95% CI, 51.2-72.5) increased the probability of cancer to 71.8% (95% CI, 67.0%-76.6%), whereas a negative hysteroscopy result (pooled LR, 0.15; 95% CI, 0.13-0.18) reduced the probability of cancer to 0.6% (95% CI, 0.5%-0.8%). There was statistical heterogeneity in pooling of LRs, but an explanation for this could not be found in spectrum composition and study quality. The overall accuracy for the diagnosis of endometrial disease was modest compared with that of cancer, and the results were heterogeneous. The accuracy tended to be higher among postmenopausal women and in the outpatient setting.
The diagnostic accuracy of hysteroscopy is high for endometrial cancer, but only moderate for endometrial disease (cancer or hyperplasia).
宫腔镜检查（直接通过内镜观察子宫内膜腔）广泛应用于常见妇科问题的评估，如月经过多和绝经后出血。然而，对于这项技术在严重子宫内膜疾病诊断中的价值仍存在持续的争论。
确定宫腔镜检查在诊断异常子宫出血女性子宫内膜癌和增生中的准确性。
通过检索Cochrane图书馆、MEDLINE和EMBASE（1984 - 2001年）、人工检索已知的原始文献和综述文章的参考文献目录以及与制造商联系来识别相关文章。
如果以组织病理学结果作为参考标准来评估宫腔镜检查在异常子宫出血女性中的准确性，则对研究进行盲法、独立且重复的选择。我们的检索共识别出3486篇文章；其中208篇被认为可能符合条件并被检索出来进行详细的数据提取。分析了65项原始研究，包括26346名女性。
从每项研究中提取关于特征和质量的数据。分别针对子宫内膜癌和子宫内膜疾病（癌症、增生或两者皆有）提取诊断准确性的结果以形成2×2列联表。合并似然比（LRs）用作总体准确性指标。
子宫内膜癌的预测试概率为3.9%（95%置信区间[CI]，3.7% - 4.2%）。宫腔镜检查结果为阳性（合并LR，60.9；95% CI，51.2 - 72.5）使癌症概率增加到71.8%（95% CI，67.0% - 76.6%），而宫腔镜检查结果为阴性（合并LR，0.15；95% CI，0.13 - 0.18）使癌症概率降低到0.6%（95% CI，0.5% - 0.8%）。合并LRs时存在统计学异质性，但在谱组成和研究质量方面未找到对此的解释。与癌症诊断相比，子宫内膜疾病诊断的总体准确性一般，且结果存在异质性。绝经后女性和门诊环境中的准确性往往更高。
宫腔镜检查对子宫内膜癌的诊断准确性高，但对子宫内膜疾病（癌症或增生）的诊断准确性仅为中等。
