Jeng Cherng-Jye, Huang Shih-Hung, Shen Jenta, Chou Chun-Shan, Tzeng Chii-Ruey
Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, and Department of Pathology, Cathay General Hospital, Taipei 110, Taiwan.
Hum Reprod. 2007 Jul;22(7):2016-9. doi: 10.1093/humrep/dem084. Epub 2007 Apr 11.
The purpose of this study was to investigate the usefulness of laparoscopy-guided myometrial biopsy in the diagnosis of diffuse adenomyosis.
This prospective non-randomized study (Canadian Task Force classification II-1) was conducted in a tertiary medical center. One hundred patients who had clinical signs and symptoms strongly suggestive of adenomyosis were included as the study sample. Transvaginal sonography, serum CA-125 determination and laparoscopy-guided myometrial biopsy were performed.
The mean largest myometrial thickness was 3.10+/-0.56 cm (range 2.30-4.50). The mean serum CA-125 level was 49.64+/-38.30 U/ml (range 10.90-205.28). Of these 100 patients, adenomyosis was pathologically proven in 92 patients, small leiomyoma in four patients and myometrial hypertrophy in four patients. The sensitivity of myometrial biopsy was 98% and the specificity 100%; the positive predictive value was 100% and the negative predictive value 80%, which were superior to those of transvaginal sonography, serum CA-125 determination or the combination of both.
Laparoscopy-guided myometrial biopsy is a valuable tool for obtaining a definite diagnosis of diffuse adenomyosis with preservation of the uterus in infertility workup or in the evaluation of dysmenorrhea or chronic pelvic pain.
本研究的目的是探讨腹腔镜引导下子宫肌层活检在弥漫性子宫腺肌病诊断中的实用性。
本前瞻性非随机研究（加拿大工作组分类II-1）在一家三级医疗中心进行。纳入100例临床症状和体征强烈提示子宫腺肌病的患者作为研究样本。进行经阴道超声检查、血清CA-125测定和腹腔镜引导下子宫肌层活检。
子宫肌层最大平均厚度为3.10±0.56cm（范围2.30-4.50cm）。血清CA-125平均水平为49.64±38.30U/ml（范围10.90-205.28U/ml）。在这100例患者中，92例经病理证实为子宫腺肌病，4例为小子宫肌瘤，4例为子宫肌层肥大。子宫肌层活检的敏感性为98%，特异性为100%；阳性预测值为100%，阴性预测值为80%，均优于经阴道超声检查、血清CA-125测定或两者联合。
腹腔镜引导下子宫肌层活检是在不孕症检查或痛经或慢性盆腔疼痛评估中保留子宫以明确诊断弥漫性子宫腺肌病的有价值工具。
