Ribeiro Camila Toffoli, Rosa-E-Silva Júlio César, Silva-de-Sá Marcos Felipe, Rosa-E-Silva Ana Carolina Japur de Sá, Poli Neto Omero Benedicto, Candido Dos Reis Francisco José, Nogueira Antonio Alberto
Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
Sao Paulo Med J. 2007 Nov 1;125(6):338-42. doi: 10.1590/s1516-31802007000600007.
Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity.
Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo.
Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy.
There were 510 patients, with a mean age of 61.1+/-2.0 years and mean time elapsed since the menopause of 12.7+/-2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively.
Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.
子宫内膜癌是生殖道最常见的恶性肿瘤类型。本研究的目的是计算诊断性宫腔镜检查相对于组织病理学检查对于所有子宫内膜腔病变的敏感性、特异性、准确性以及阳性和阴性预测值。
在圣保罗大学医学院里贝朗普雷图分校的公立三级大学医院进行的回顾性描述性研究。
在以下情况下进行诊断性宫腔镜检查：无症状患者子宫内膜厚度>4mm；绝经后出血；以及超声检查显示子宫内膜不规则或难以评估，无论有无阴道出血。在宫腔镜检查前不超过三个月进行超声评估。
共有510例患者，平均年龄为61.1±2.0岁，绝经后平均时间为12.7±2.5年。293例患者（57.5%）进行了子宫内膜活检。组织病理学分析显示，18例患者存在子宫内膜癌或典型或非典型增生，且他们中无一例子宫内膜厚度小于8mm。各种良性病变的中位数厚度之间未发现显著差异（p>0.05）。在我们的数据中，癌症或增生的敏感性、特异性、准确性以及阳性和阴性预测值分别为94.4%、97.0%、96.8%、68%和99.6%。
我们的结果表明，宫腔镜检查作为一种诊断工具，对于恶性/增生性和良性病变是有价值的，但对于黏膜下肌瘤，其敏感性仅为52.6%。
