Dueholm Margit, Marinovskij Edvard, Hansen Estrid Stær, Møller Charlotte, Ørtoft Gitte
From the 1Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark; 2Department of Diagnostic Imaging, Aarhus University Hospital, Aarhus N, Denmark; and 3Department of Pathology, Aarhus University Hospital, Aarhus N, Denmark.
Menopause. 2015 Jun;22(6):616-26. doi: 10.1097/GME.0000000000000358.
This study aims to evaluate the diagnostic efficiency of pattern recognition by transvaginal ultrasonography (TVS) and gel infusion sonography (GIS) for identifying endometrial pathology and to compare this setup with a standard setup of endometrial sampling (ES), hysteroscopy with pattern evaluation (HY(pattern)), or magnetic resonance imaging (MRI).
This study used a prospective cohort of 174 women with postmenopausal bleeding and endometrial thickness of 5 mm or greater. Resectoscopic biopsy (hysteroscopy with biopsy) samples or hysterectomy served as reference standard. Malignant and benign endometrial patterns were evaluated with TVS, GIS and HY(pattern) were then added. The efficiency of each diagnostic strategy, including ES and MRI findings (n = 83), was compared and evaluated against the reference standard.
ES, TVS, GIS, and HY(pattern) had high diagnostic efficiency (area under the curve) for malignancy diagnosis (ES, 0.90; TVS, 0.88; GIS, 0.92; HY(pattern), 0.91). When insufficient samples were incorporated, ES was less efficient than the other techniques. ES was not more efficient in the subgroup of women without localized lesions than in the subgroup of women with localized lesions. MRI and HY(pattern) added limited efficiency, whereas hysteroscopy with biopsy was most efficient.
As a first-line technique, pattern recognition on TVS, GIS, and HY(pattern) correctly identifies 9 of 10 women with malignancy and is superior to pattern recognition on ES when insufficient samples are included. Endometrial pattern evaluated with TVS and GIS is a fast and efficient first-line diagnostic tool that outperforms ES in women with or without localized lesions. Malignant patterns on TVS/GIS should warrant fast-track evaluation, whereas women with benign patterns may be selected for office or operative hysteroscopy. A fast-track diagnostic setup based on pattern recognition is presented.
本研究旨在评估经阴道超声检查（TVS）和凝胶注入超声检查（GIS）的模式识别对子宫内膜病变的诊断效能，并将此检查方案与子宫内膜取样（ES）、模式评估宫腔镜检查（HY（模式））或磁共振成像（MRI）的标准检查方案进行比较。
本研究采用前瞻性队列研究，纳入174例绝经后出血且子宫内膜厚度≥5mm的女性。以宫腔镜下活检（宫腔镜检查联合活检）样本或子宫切除术作为参考标准。通过TVS评估恶性和良性子宫内膜模式，随后增加GIS和HY（模式）。将包括ES和MRI检查结果（n = 83）在内的每种诊断策略的效能与参考标准进行比较和评估。
ES、TVS、GIS和HY（模式）在恶性肿瘤诊断方面具有较高的诊断效能（曲线下面积）（ES为0.90；TVS为0.88；GIS为0.92；HY（模式）为0.91）。当纳入样本不足时，ES的效能低于其他技术。在无局限性病变的女性亚组中，ES的效能并不高于有局限性病变的女性亚组。MRI和HY（模式）增加的效能有限，而宫腔镜检查联合活检的效能最高。
作为一线技术，TVS、GIS和HY（模式）的模式识别能正确识别十分之九的恶性肿瘤女性患者，且在纳入样本不足时优于ES的模式识别。通过TVS和GIS评估的子宫内膜模式是一种快速有效的一线诊断工具，在有或无局限性病变的女性中均优于ES。TVS/GIS上的恶性模式应进行快速评估，而良性模式的女性可选择门诊或手术宫腔镜检查。本文提出了一种基于模式识别的快速诊断方案。
