Zeynep Kamil Training and Education Hospital, Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2012 Mar;161(1):66-70. doi: 10.1016/j.ejogrb.2011.11.022. Epub 2011 Dec 10.
The aim of this study was to compare the diagnostic effectiveness of transvaginal sonography (TVS), saline infusion sonohysterography (SIS), and diagnostic hysteroscopy (HS), with the pathologic specimen as a gold standard diagnostic method, in detecting endometrial pathology in premenopausal women with abnormal uterine bleeding.
This prospective cohort study was conducted at Zeynep Kamil Education and Training Hospital, Istanbul, Turkey, and included 89 premenopausal women. All participants were examined first by TVS, further investigated with SIS and HS, and finally dilatation and curettage was performed when needed. The results obtained from these three methods were compared with the pathologic diagnoses. The positive and negative likelihood ratios (LR+ and LR-) of TVS, SIS and HS were calculated by comparison with the final pathological diagnosis. In addition, area under the curve (AUC) values were also calculated.
Polypoid lesion was the most common abnormal pathology. LR+ and LR- of TVS, SIS, and HS were 3.13 and 0.15, 9.83 and 0.07, 13.7 and 0.02 respectively in detection of any abnormal pathology, and the AUCs of TVS, SIS, and HS were 0.804, 0.920, and 0.954 respectively. When the three procedures were compared with each other separately, HS had the best diagnostic accuracy, and the diagnostic accuracy of HS and SIS was superior to TVS (p(1)=0.000, p(2)=0.000). For the detection of polypoid lesions, HS was the most accurate diagnostic procedure (AUC=0.947), followed by SIS (AUC=0.894) and TVS (AUC=0.778).
HS provides the most accurate diagnosis and allows treatment in the same session in premenopausal women with abnormal uterine bleeding.
本研究旨在比较经阴道超声（TVS）、生理盐水宫腔灌注超声（SIS）和诊断性宫腔镜（HS）三种方法与病理标本作为金标准诊断方法，在诊断绝经前异常子宫出血女性子宫内膜病变中的诊断效能。
本前瞻性队列研究在土耳其伊斯坦布尔泽耶普·卡米尔教育和培训医院进行，共纳入 89 例绝经前女性。所有参与者首先接受 TVS 检查，进一步进行 SIS 和 HS 检查，必要时进行扩张和刮宫。将这三种方法的结果与病理诊断进行比较。通过与最终病理诊断比较，计算 TVS、SIS 和 HS 的阳性和阴性似然比（LR+和 LR-）。此外，还计算了曲线下面积（AUC）值。
息肉样病变是最常见的异常病理。TVS、SIS 和 HS 检测任何异常病理的 LR+和 LR-分别为 3.13 和 0.15、9.83 和 0.07、13.7 和 0.02，TVS、SIS 和 HS 的 AUC 值分别为 0.804、0.920 和 0.954。当单独比较这三种方法时，HS 的诊断准确性最佳，HS 和 SIS 的诊断准确性优于 TVS（p(1)=0.000，p(2)=0.000）。对于息肉样病变的检测，HS 是最准确的诊断程序（AUC=0.947），其次是 SIS（AUC=0.894）和 TVS（AUC=0.778）。
HS 可提供最准确的诊断，并可在绝经前异常子宫出血女性中进行同期治疗。
