孕早期超声诊断葡萄胎的准确性。

The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole.

作者信息

Kirk E, Papageorghiou A T, Condous G, Bottomley C, Bourne T

机构信息

Early Pregnancy Unit, St George's, University of London, London, UK.

Fetal Medicine Unit, St George's, University of London, London, UK.

出版信息

Ultrasound Obstet Gynecol. 2007 Jan;29(1):70-75. doi: 10.1002/uog.3875.

DOI:10.1002/uog.3875

PMID:17201012

Abstract

OBJECTIVE

Previous studies have examined ultrasound findings in histopathologically confirmed cases of hydatidiform mole. The aim of this study was to assess the first-trimester ultrasonographic findings in all women suspected of having hydatidiform mole on ultrasound and those subsequently diagnosed with hydatidiform mole after histological examination of removed products of conception after surgical evacuation of the uterus. The aim was to obtain a true sensitivity and positive predictive value for ultrasound in the diagnosis of hydatidiform mole.

METHODS

A retrospective analysis was performed of all cases of sonographically suspected hydatidiform mole and histologically proven hydatidiform mole presenting to the Early Pregnancy Unit of an inner city hospital over a 4-year period. The sensitivity and positive predictive value (PPV) of ultrasound in the detection of histologically proven hydatidiform mole was calculated.

RESULTS

The study group consisted of 90 women; 56 were suspected of having hydatidiform mole on ultrasound, and of these 27 (48%) had hydatidiform mole confirmed after histopathological examination of the products of conception, while no changes suggestive of hydatidiform mole were present in the other 29 cases. Overall, 61 women had hydatidiform mole confirmed on histology-41 (67%) partial hydatidiform moles (PHM) and 20 (33%) complete hydatidiform moles (CHM). The ultrasound findings in the 34 cases not suspected of hydatidiform mole were an empty sac in 8/34 (24%) women and a delayed miscarriage in the other 26/34 (76%). The overall sensitivity and positive predictive value for the ultrasound diagnosis of hydatidiform mole was 44% and 48%, respectively. For PHMs the respective values were 20% and 22% and for CHMs they were 95% and 40%.

CONCLUSION

Ultrasonography is more reliable for diagnosing CHMs than for PHMs. Overall, the sensitivity of ultrasound for accurately predicting hydatidiform mole is 44%, and one in two women with an abnormal scan will have the disease confirmed on histology.

摘要

目的

既往研究已对经组织病理学确诊的葡萄胎病例的超声检查结果进行了分析。本研究的目的是评估所有超声检查怀疑为葡萄胎且在子宫手术排空后对取出的妊娠产物进行组织学检查后被诊断为葡萄胎的女性在孕早期的超声检查结果。目的是获得超声诊断葡萄胎的真实敏感性和阳性预测值。

方法

对一家市中心医院早孕科在4年期间接诊的所有超声怀疑为葡萄胎且经组织学证实为葡萄胎的病例进行回顾性分析。计算超声检测经组织学证实的葡萄胎的敏感性和阳性预测值（PPV）。

结果

研究组包括90名女性；56名超声检查怀疑为葡萄胎，其中27名（48%）在对妊娠产物进行组织病理学检查后确诊为葡萄胎，而其他29例未发现提示葡萄胎的变化。总体而言，61名女性经组织学确诊为葡萄胎，其中41例（67%）为部分性葡萄胎（PHM），20例（33%）为完全性葡萄胎（CHM）。34例未怀疑为葡萄胎的病例中，超声检查结果为8/34（24%）女性为空囊，其他26/34（76%）为稽留流产。超声诊断葡萄胎的总体敏感性和阳性预测值分别为44%和48%。对于部分性葡萄胎，相应的值分别为20%和22%，对于完全性葡萄胎，分别为95%和40%。