Garuti Giancarlo, Mirra Maurizio, Luerti Massimo
Obstetrics and Gynecology Department, Lodi Hospital, Lodi, Italy.
J Minim Invasive Gynecol. 2006 Jul-Aug;13(4):325-30. doi: 10.1016/j.jmig.2006.03.010.
To evaluate whether hysteroscopic imaging can contribute to decrease the rate of undetected endometrial carcinomas concurrent with atypical hyperplasia diagnosed by endometrial biopsy.
Retrospective study.
Canadian Task Force Classification II-3.
Public hospital.
Hysteroscopic reports of 25 menopausal patients undergoing endometrial biopsy yielding a diagnosis of atypical hyperplasia were reviewed. On the basis of this diagnosis, all patients were treated by hysterectomy, and the pathologic findings on the uterine specimen were correlated with the diagnoses obtained by hysteroscopic view.
Hysteroscopy was video-assisted and carried out with normal saline solution used as liquid distension medium; a 5-mm sheathed hysteroscope, with a working channel, was used for each examination. After hysteroscopic inspection, an endometrial sampling targeted under vision was performed by mechanical or electrosurgical instrumentation. When extensive features of hyperplastic or neoplastic growth were observed, we combined a blind sampling procedure with Vabra-curettage. We calculated the sensitivity, specificity, and negative and positive predictive values of hysteroscopic inspection to foresee the diagnosis of endometrial cancer incidentally detected on hysterectomy specimen.
On the basis of histopathologic study of uterine specimens, non atypical hyperplasias were detected in 3 patients, the diagnosis of complex atypical hyperplasia was confirmed in 11 patients, whereas a concurrent infiltrating endometrial adenocarcinoma was detected in 11 patients (44.0%). In the 14 patients with diagnosis of endometrial hyperplasia, no feature suggesting endometrial malignancy was reported by hysteroscopic inspection. In the 11 cases showing infiltrating carcinomas, hysteroscopic view was consistent with endometrial malignancy in 9 patients and with endometrial hyperplasia in 2 patients. An intramucous endometrial carcinoma without evidence of myometrial invasion was found on hysterectomy specimens of these two latter patients. From these figures, sensitivity, specificity, and negative and positive predictive values of hysteroscopy to foresee a diagnosis of infiltrating carcinoma were 84.6%, 100%, 87.5%, and 100%, respectively.
Hysteroscopic view is a sensitive and specific method to identify among patients with a diagnosis of atypical hyperplasia on endometrial biopsy those with a coexisting infiltrating carcinoma.
评估宫腔镜成像是否有助于降低在经子宫内膜活检诊断为非典型增生的同时未被发现的子宫内膜癌的发生率。
回顾性研究。
加拿大工作组分类II-3。
公立医院。
回顾了25例接受子宫内膜活检诊断为非典型增生的绝经患者的宫腔镜检查报告。基于此诊断，所有患者均接受了子宫切除术治疗，并将子宫标本的病理结果与宫腔镜检查结果进行了对比。
宫腔镜检查采用视频辅助，使用生理盐水作为液体扩张介质；每次检查均使用带有工作通道的5毫米鞘状宫腔镜。宫腔镜检查后，在直视下通过机械或电外科器械进行子宫内膜取样。当观察到增生或肿瘤生长的广泛特征时，我们将盲目取样程序与Vabra刮宫术相结合。我们计算了宫腔镜检查对预见子宫切除标本中偶然发现的子宫内膜癌诊断的敏感性、特异性、阴性和阳性预测值。
基于子宫标本的组织病理学研究，3例患者检测到非非典型增生，11例患者确诊为复杂性非典型增生，而11例患者（44.0%）检测到同时存在浸润性子宫内膜腺癌。在14例诊断为子宫内膜增生的患者中，宫腔镜检查未报告提示子宫内膜恶性肿瘤的特征。在11例显示浸润性癌的病例中，9例患者的宫腔镜检查结果与子宫内膜恶性肿瘤一致，2例患者的结果与子宫内膜增生一致。在这后两名患者的子宫切除标本中发现了无肌层浸润证据的黏膜内子宫内膜癌。根据这些数据，宫腔镜检查预见浸润性癌诊断的敏感性、特异性、阴性和阳性预测值分别为84.6%、100%、87.5%和100%。
宫腔镜检查是一种敏感且特异的方法，可用于在经子宫内膜活检诊断为非典型增生的患者中识别出同时存在浸润性癌的患者。
