二维及三维超声造影宫腔声学造影：观察者间的一致性、与宫腔镜的一致性和子宫内膜恶性肿瘤的诊断。

Two- and three-dimensional saline contrast sonohysterography: interobserver agreement, agreement with hysteroscopy and diagnosis of endometrial malignancy.

机构信息

Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Malmö, Sweden.

出版信息

Ultrasound Obstet Gynecol. 2009 May;33(5):574-82. doi: 10.1002/uog.6350.

DOI:10.1002/uog.6350

PMID:19360790

Abstract

OBJECTIVES

The aims of our study were to compare the interobserver reproducibility of two-dimensional (2D) and three-dimensional (3D) saline contrast sonohysterography (SCSH) and agreement of these techniques with hysteroscopy, and to determine which SCSH findings best discriminate between benign and malignant endometrium.

METHODS

Consecutive women with postmenopausal bleeding and endometrial thickness > or = 4.5 mm underwent 2D and 3D SCSH; the results were videotaped and stored electronically, respectively, for analysis by two independent experienced examiners who were blinded to each other's results. A histological diagnosis was obtained by dilatation and curettage, hysteroscopic resection or hysterectomy. The hysteroscopist was blinded to the ultrasound results and used the same standardized research protocol to describe the uterine cavity as the ultrasound examiners.

RESULTS

Of 170 consecutive women with postmenopausal bleeding and endometrial thickness > or = 4.5 mm, 84 (14 with endometrial malignancy) fulfilled our inclusion criteria. Hysteroscopy findings in 54 women (one with endometrial malignancy) were used to determine agreement with SCSH. Interobserver agreement of 2D and 3D SCSH was 95% (80/84) vs. 89% (75/84) with regard to presence of focal lesions, 89% (75/84) vs. 88% (74/84) for presence of focal lesions with irregular surface, 67% (54/81) vs. 63% (51/81) for number of focal lesions, and 77% (46/60) vs. 70% (42/60) for location of focal lesions. The agreement between 2D and 3D SCSH and hysteroscopy was 94% (51/54) vs. 93% (50/54) with regard to presence of focal lesions, 74% (40/54) vs. 76% (41/54) for presence of focal lesions with irregular surface, 63% (34/54) vs. 54% (29/54) for number of focal lesions, and 66% (29/44) vs. 64% (28/44) for location of focal lesions. The SCSH finding that best discriminated between benign and malignant endometrium was the presence of focal lesion(s) with irregular surface (for 2D SCSH: sensitivity 71%, specificity 97%, positive likelihood ratio 25, negative likelihood ratio 0.3; for 3D SCSH: sensitivity 43%, specificity 97%, positive likelihood ratio 15, negative likelihood ratio 0.6).

CONCLUSIONS

3D SCSH does not seem to be superior to 2D SCSH when performed by experienced ultrasound examiners either with regard to reproducibility, agreement with hysteroscopy findings or diagnosis of endometrial malignancy. The presence of focal lesion(s) with irregular surface is the best SCSH variable for discrimination between benign and malignant endometrium.

摘要

目的

我们研究的目的是比较二维（2D）和三维（3D）盐水对比超声子宫造影术（SCSH）的观察者间可重复性，以及这些技术与宫腔镜的一致性，并确定哪些 SCSH 发现最能区分良性和恶性子宫内膜。

方法

连续患有绝经后出血和子宫内膜厚度≥4.5mm 的女性接受 2D 和 3D SCSH；结果分别录像并以电子方式存储，以供两名独立的经验丰富的检查者进行分析，他们彼此的结果均不知情。通过扩张和刮宫术、宫腔镜切除术或子宫切除术获得组织学诊断。宫腔镜检查者对超声结果一无所知，并使用相同的标准化研究方案来描述子宫腔，就像超声检查者一样。

结果

在 170 名患有绝经后出血和子宫内膜厚度≥4.5mm 的连续女性中，有 84 名（14 名患有子宫内膜恶性肿瘤）符合我们的纳入标准。54 名女性（1 名患有子宫内膜恶性肿瘤）的宫腔镜检查结果用于确定与 SCSH 的一致性。2D 和 3D SCSH 对存在局灶性病变的观察者间一致性分别为 95%（80/84）和 89%（75/84），存在不规则表面局灶性病变的一致性分别为 89%（75/84）和 88%（74/84），局灶性病变的数量分别为 67%（54/81）和 63%（51/81），局灶性病变的位置分别为 77%（46/60）和 70%（42/60）。2D 和 3D SCSH 与宫腔镜检查的一致性分别为存在局灶性病变的 94%（51/54）和 93%（50/54），存在不规则表面局灶性病变的 74%（40/54）和 76%（41/54），局灶性病变的数量分别为 63%（34/54）和 54%（29/54），局灶性病变的位置分别为 66%（29/44）和 64%（28/44）。最好区分良性和恶性子宫内膜的 SCSH 发现是存在不规则表面的局灶性病变（对于 2D SCSH：敏感性 71%，特异性 97%，阳性似然比 25，阴性似然比 0.3；对于 3D SCSH：敏感性 43%，特异性 97%，阳性似然比 15，阴性似然比 0.6）。