经阴道超声检查对不孕女性子宫异常的诊断准确性。
Diagnostic accuracy of transvaginal sonography in the detection of uterine abnormalities in infertile women.
作者信息
Niknejadi Maryam, Haghighi Hadieh, Ahmadi Firoozeh, Niknejad Fatemeh, Chehrazi Mohammad, Vosough Ahmad, Moenian Deena
机构信息
Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran.
出版信息
Iran J Radiol. 2012 Sep;9(3):139-44. doi: 10.5812/iranjradiol.8063. Epub 2012 Sep 17.
BACKGROUND
Accurate diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities.
OBJECTIVES
This study was designed to assess the diagnostic accuracy of transvaginal ultrasonography (TVS) in uterine pathologies of infertile patients using hysteroscopy as the gold standard.
PATIENTS AND METHODS
This was a cross-sectional study carried out in the Department of Reproductive Imaging at Royan Institute from October 2007 to October 2008. In this study, the medical documents of 719 infertile women who were investigated with transvaginal ultrasound (TVS) and then hysteroscopy were reviewed. All women underwent hysteroscopy in the same cycle time after TVS. Seventy-six out of 719 patients were excluded from the study and 643 patients were studied. TVS was performed in the follicular phase after cessation of bleeding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for TVS. Hysteroscopy served as the gold standard.
RESULTS
The overall sensitivity, specificity, positive and negative predictive values for TVS in the diagnosis of uterine abnormality was 79%, 82%, 84% and 71%, respectively. The sensitivity and PPV of TVS in detection of polyp were 88.3% and 81.6%, respectively. These indices were 89.2% and 92.5%, respectively for fibroma, 67% and 98.3%, respectively for subseptated uterus and 90.9% and 100%, respectively for septated uterus. Adhesion and unicornuated uterus have the lowest sensitivity with a sensitivity of 35% and PPV of 57.1%.
CONCLUSION
TVS is a cost-effective and non-invasive method for diagnosis of intrauterine lesions such as polyps, submucosal fibroids and septum. It is a valuable adjunctive to hysteroscopy with high accuracy for identification and characterization of intrauterine abnormalities. This may lead to a more precise surgery plan and performance.
背景
子宫异常的准确诊断已成为生育评估的核心部分。多种检查方式可用于子宫异常的诊断。
目的
本研究旨在以宫腔镜检查作为金标准，评估经阴道超声检查（TVS）对不孕患者子宫病变的诊断准确性。
患者与方法
这是一项于2007年10月至2008年10月在罗扬研究所生殖影像科开展的横断面研究。本研究回顾了719例接受经阴道超声（TVS）检查后再行宫腔镜检查的不孕女性的病历资料。所有女性在TVS检查后的同一周期时间内接受宫腔镜检查。719例患者中有76例被排除在研究之外，对643例患者进行了研究。TVS检查在出血停止后的卵泡期进行。计算TVS的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。宫腔镜检查作为金标准。
结果
TVS诊断子宫异常的总体敏感性、特异性、阳性和阴性预测值分别为79%、82%、84%和71%。TVS检测息肉的敏感性和PPV分别为88.3%和81.6%。纤维瘤的这些指标分别为89.2%和92.5%，不全纵隔子宫分别为67%和98.3%，完全纵隔子宫分别为90.9%和100%。粘连和单角子宫的敏感性最低，分别为35%，PPV为57.1%。
结论
TVS是诊断息肉、黏膜下肌瘤和纵隔等宫内病变的一种经济有效且无创的方法。它是宫腔镜检查的一种有价值的辅助手段，对宫内异常的识别和特征描述具有较高的准确性。这可能会带来更精确的手术计划和操作。
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