Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Arch Gynecol Obstet. 2012 Mar;285(3):839-43. doi: 10.1007/s00404-011-2068-6. Epub 2011 Aug 26.
The goal of this study was to define the diagnostic value of hysteroscopy in evaluating uterine cavity compared to endometrial biopsy in women presenting with postmenopausal bleeding and thick endometrial mucosa with particular attention to endometrial hyperplasia and carcinoma.
Eighty-three consecutive women presenting with postmenopausal bleeding and endometrial thickness of 5 mm or more measured by transvaginal ultrasound (TVU) were enrolled in a prospective study between May 2008 and July 2010. They underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopic data was compared with the final diagnosis established by histological examination.
The women's mean age was 61.2 ± 5.2 years (range 44-80). The most frequent endometrial lesion was endometrial polyps (31.1%). Hyperplastic endometrium was confirmed in 23 (27.8%), only 13 cases were suspected by the hysteroscope. Out of the 14 (16.9%) proven cases of endometrial cancer, only half of the cases were suspected. In benign endometrial lesions, the sensitivity of the hysteroscopic view was 94.7%, specificity was 97.8%, positive (PPV) and negative (NPV) predictive values were 97.3 and 95.7%, respectively. On the other hand, hysteroscopy demonstrated an overall sensitivity, specificity, PPV, and NPV of 56.5, 91.6, 72.2, and 84.6%, respectively, in endometrial hyperplasia, whereas the same parameters for endometrial cancer were 50, 94.2, 63.6, and 90.2%.
Hysteroscopy can be used as the first line diagnostic tool for evaluating the benign endometrial lesions, such as endometrial polyp and submucosal myoma, nonetheless hysteroscopy has poor validity for excluding endometrial hyperplasia and cancer in women presenting with the postmenopausal bleeding and thick endometrium.
本研究旨在定义宫腔镜检查在评估绝经后出血和子宫内膜增厚（经阴道超声测量厚度≥5mm）患者宫腔情况的诊断价值，特别关注子宫内膜增生和癌。
2008 年 5 月至 2010 年 7 月，连续 83 例绝经后出血且子宫内膜厚度≥5mm 的患者入组本前瞻性研究，行诊断性宫腔镜检查和子宫内膜活检。将宫腔镜检查结果与组织学检查最终诊断进行比较。
患者的平均年龄为 61.2±5.2 岁（44-80 岁）。最常见的子宫内膜病变是子宫内膜息肉（31.1%）。经宫腔镜检查证实为增生性子宫内膜 23 例（27.8%），其中仅 13 例可疑。14 例（16.9%）证实为子宫内膜癌中，仅一半可疑。在良性子宫内膜病变中，宫腔镜检查的敏感性为 94.7%，特异性为 97.8%，阳性预测值（PPV）和阴性预测值（NPV）分别为 97.3%和 95.7%。另一方面，宫腔镜检查对子宫内膜增生的总体敏感性、特异性、PPV 和 NPV 分别为 56.5%、91.6%、72.2%和 84.6%，而子宫内膜癌的相应参数分别为 50%、94.2%、63.6%和 90.2%。
宫腔镜检查可作为评估良性子宫内膜病变（如子宫内膜息肉和黏膜下肌瘤）的一线诊断工具，但对于排除绝经后出血和子宫内膜增厚患者的子宫内膜增生和癌，宫腔镜检查的有效性较差。
