van Dongen H, de Kroon C D, Jacobi C E, Trimbos J B, Jansen F W
Department of Gynaecology, Leiden Unviersity Medical Center, Leiden, The Netherlands.
BJOG. 2007 Jun;114(6):664-75. doi: 10.1111/j.1471-0528.2007.01326.x.
This study was conducted to assess the accuracy and feasibility of diagnostic hysteroscopy in the evaluation of intrauterine abnormalities in women with abnormal uterine bleeding.
Electronic databases were searched from 1 January 1965 to 1 January 2006 without language selection. The medical subject heading (MeSH) and textwords for the following terms were used: hysteroscopy, diagnosis, histology, histopathology, hysterectomy, biopsy, sensitivity and specificity.
University Hospital.
The inclusion criteria were report on accuracy of diagnostic hysteroscopy in women with abnormal uterine bleeding compared to histology collected with guided biopsy during hysteroscopy, operative hysteroscopy or hysterectomy.
Electronic databases were searched for relevant studies and references were cross-checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated and data were pooled. Subgroup analysis was performed according to validity criteria, study quality, menopausal state, time, setting and performance of the procedure. The pooled sensitivity, specificity, likelihood ratios, post-test probabilities and feasibility of diagnostic hysteroscopy on the prediction of uterine cavity abnormalities. Post-test probabilities were derived from the likelihood ratios and prevalence of intrauterine abnormalities among included studies. Feasibility included technical success rate and complication rate.
One population of homogeneous data could be identified, consisting of patients with postmenopausal bleeding. In this subgroup the positive and negative likelihood ratios were 7.9 (95% CI 4.79-13.10) and 0.04 (95% CI 0.02-0.09), raising the pre-test probability from 0.61 to a post-test probability of 0.93 (95% CI 0.88-0.95) for positive results and reducing it to 0.06 (95% CI 0.03-0.13) for negative results. The pooled likelihood ratios of all studies included, calculated with the random effects model, were 6.5 (95% CI 4.1-10.4) and 0.08 (95% CI 0.07-0.10), changing the pre-test probability of 0.46 to post-test probabilities of 0.85 (95% CI 0.78-0.90) and 0.07 (0.06-0.08) for positive and negative results respectively. Subgroup analyses gave similar results. The overall success rate of diagnostic hysteroscopy was estimated at 96.9% (SD 5.2%, range 83-100%).
This systematic review and meta-analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities.
本研究旨在评估诊断性宫腔镜检查在评估子宫异常出血女性子宫内异常情况时的准确性和可行性。
检索了1965年1月1日至2006年1月1日的电子数据库，无语言限制。使用了以下医学主题词（MeSH）和文本词：宫腔镜检查、诊断、组织学、组织病理学、子宫切除术、活检、敏感性和特异性。
大学医院。
纳入标准为关于诊断性宫腔镜检查在子宫异常出血女性中的准确性报告，与宫腔镜检查、手术宫腔镜检查或子宫切除术中在引导下活检所收集的组织学结果相比较。
检索电子数据库以查找相关研究，并交叉核对参考文献。由两位作者独立评估有效性并提取数据。计算异质性并汇总数据。根据有效性标准、研究质量、绝经状态、时间、研究地点和操作的性能进行亚组分析。汇总诊断性宫腔镜检查在预测子宫腔异常方面的敏感性、特异性、似然比、验后概率和可行性。验后概率由似然比和纳入研究中子宫内异常的患病率得出。可行性包括技术成功率和并发症发生率。
可以确定一组同质数据，由绝经后出血患者组成。在该亚组中，阳性和阴性似然比分别为7.9（95%可信区间4.79 - 13.10）和0.04（95%可信区间0.02 - 0.09），阳性结果使验前概率从0.61提高到验后概率0.93（95%可信区间0.88 - 0.95），阴性结果使其降至0.06（95%可信区间0.03 - 0.13）。纳入的所有研究使用随机效应模型计算的汇总似然比为6.5（95%可信区间4.1 - 10.4）和0.08（95%可信区间0.07 - 0.10），阳性和阴性结果分别将验前概率0.46改变为验后概率0.85（95%可信区间0.78 - 0.90）和0.07（0.06 - 0.08）。亚组分析得出类似结果。诊断性宫腔镜检查的总体成功率估计为96.9%（标准差5.2%，范围83 - 100%）。
本系统评价和荟萃分析表明，诊断性宫腔镜检查在诊断子宫内异常方面既准确又可行。
