Garuti Giancarlo, Cellani Fulvia, Garzia Delia, Colonnelli Monica, Luerti Massimo
Department of Obstetrics and Gynecology, Lodi Hospital, Lodi, Italy.
J Minim Invasive Gynecol. 2005 May-Jun;12(3):247-53. doi: 10.1016/j.jmig.2005.03.006.
To evaluate the diagnostic accuracy of hysteroscopic view in endometrial hyperplasia.
Retrospective study (Canadian Task Force classification II-2).
Public hospital in northern Italy.
Three hundred twenty-three patients suffering from endometrial hyperplasia out of 2251 women (1119 premenopausal and 1132 postmenopausal) who underwent office-based hysteroscopy from January 1996 through May 2004.
Review of 2251 outpatient hysteroscopies carried out with 5- to 6-mm sheathed hysteroscopes and accomplished with blind or hysteroscopically targeted endometrial biopsies.
The pathologic report was considered the reference test. Hysteroscopic detection of focal or extensive endometrial thickening, irregular vascular network, architectural distortion and crowding of gland openings, and gland cyst formation were considered endoscopic features consistent with hyperplasia. Overall sensitivity, specificity, negative predictive values (NPV), and positive predictive values (PPV) of hysteroscopy in order to foresee a diagnosis of hyperplasia were calculated. These figures were calculated both in premenopausal and postmenopausal patients. Histopathology yielded a diagnosis of simple, complex, and atypical hyperplasia in 247, 51, and 25 patients, respectively. Hysteroscopy foresaw hyperplasia in 38.4% of patients with simple hyperplasia and in 58.9% of patients with complex or atypical hyperplasia. Normal hysteroscopic findings underestimated simple hyperplasia in 34 patients (13.7%) and complex or atypical hyperplasias in 1 patient (1.3%) (p <.01). To predict the diagnosis of hyperplasia, hysteroscopy showed an overall sensitivity, specificity, NPV, and PPV of 63.7%, 91.7%, 91.3%, and 64.7%, respectively. Among premenopausal patients, hyperplasia was diagnosed in 134 women (11.9%); in this group, hysteroscopy showed sensitivity, specificity, NPV, and PPV of 65.6%, 88.5%%, 93.5%, and 50.5%, respectively. In postmenopausal patients, we found endometrial hyperplasia in 189 women (16.6%); sensitivity, specificity, NPV, and PPV of hysteroscopic view to anticipate hyperplasia were 61.6%, 95.2%, 89.3%, and 79.4%, respectively. A significantly better PPV to foresee hyperplasia was found in postmenopausal women compared with premenopausal patients (p <.01).
Current hysteroscopic criteria suggesting endometrial hyperplasia are inaccurate; in order to exclude hyperplasia, a pathologic assessment is warranted in all hysteroscopies showing an irregularly lined or thick endometrium.
评估宫腔镜检查对子宫内膜增生的诊断准确性。
回顾性研究（加拿大工作组分类II-2）。
意大利北部的公立医院。
在1996年1月至2004年5月期间接受门诊宫腔镜检查的2251名女性中，有323例患有子宫内膜增生（1119例绝经前患者和1132例绝经后患者）。
回顾2251例门诊宫腔镜检查，使用5至6毫米鞘状宫腔镜，并进行盲法或宫腔镜靶向子宫内膜活检。
病理报告被视为参考标准。宫腔镜检查发现局灶性或广泛性子宫内膜增厚、不规则血管网络、结构扭曲、腺体开口拥挤以及腺囊肿形成等内镜特征被认为与增生相符。计算了宫腔镜检查预测增生诊断的总体敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。这些数据在绝经前和绝经后患者中分别进行了计算。组织病理学诊断分别在247例、51例和25例患者中诊断出单纯性、复杂性和非典型增生。宫腔镜检查预测出38.4%的单纯性增生患者和58.9%的复杂性或非典型增生患者患有增生。正常的宫腔镜检查结果低估了34例（13.7%）单纯性增生患者和1例（1.3%）复杂性或非典型增生患者（p<.01）。为预测增生的诊断，宫腔镜检查的总体敏感性、特异性、NPV和PPV分别为63.7%、91.7%、91.3%和64.7%。在绝经前患者中，134名女性（11.9%）被诊断为增生；在该组中，宫腔镜检查的敏感性、特异性、NPV和PPV分别为65.6%、88.5%、93.5%和50.5%。在绝经后患者中，我们发现189名女性（16.6%）患有子宫内膜增生；宫腔镜检查预测增生的敏感性、特异性、NPV和PPV分别为61.6%、95.2%、89.3%和79.4%。与绝经前患者相比，绝经后女性预测增生的PPV明显更高（p<.01）。
目前提示子宫内膜增生的宫腔镜检查标准不准确；为排除增生，对于所有显示子宫内膜 lining 不规则或增厚的宫腔镜检查，均需进行病理评估。
