Guven M A, Bese T, Demirkiran F
Department of Obstetrics and Gynecology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
Int J Gynecol Cancer. 2004 Jan-Feb;14(1):57-63. doi: 10.1111/j.1048-891x.2004.14105.x.
The aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding.
Prospective, randomized, and unblinded study.
A total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 +/- 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure.
The surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results.
Hydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.
本研究旨在比较超声子宫造影与经阴道超声检查在诊断有异常子宫出血史患者的宫腔内病变时的准确性。
前瞻性、随机、非盲法研究。
共有197名年龄在23至71岁（平均年龄45.7±8.9岁）、有异常子宫出血史的女性纳入本研究，其中绝经前130名，绝经后67名。超声子宫造影由经验丰富的妇科医生在门诊进行，在经阴道超声检查后立即在相同条件下进行。将最终获得的手术病理结果与经阴道超声检查和超声子宫造影的结果进行比较。计算每种检查方法的敏感性、特异性、阳性预测值和阴性预测值。
在经阴道超声检查显示子宫内膜正常的104名女性中，手术病理检查证实50名（48%）为正常生理性子宫内膜。经阴道超声检查诊断为宫腔内病变的93名女性中，70名（75%）经手术病理结果证实。经阴道超声检查在检测宫腔内病变时的敏感性、特异性、阳性预测值和阴性预测值分别为56%、68%、75%和48%。手术病理结果显示，超声子宫造影显示子宫内膜正常的76名女性中，23名（30%）存在宫腔内病变。在超声子宫造影诊断为宫腔内病变的121名女性中，101名（81%）经手术标本组织学评估得到证实。超声子宫造影在检测宫腔内病变时的敏感性、特异性、阳性预测值和阴性预测值分别为81%、73%、83%和70%。超声子宫造影的敏感性和阴性预测值显著更高。有5例子宫内膜恶性肿瘤，其中1例恶性肿瘤位于息肉上，还有2例不典型子宫内膜增生，超声检查结果未提及。
在诊断有异常子宫出血的女性宫腔内病变时，超声子宫造影比经阴道超声检查更准确。
