Rotenberg Ohad, Renz Malte, Reimers Laura, Doulaveris Georgios, Gebb Juliana, Goldberg Gary L, Dar Pe'er
Divisions of Ultrasound and Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Obstet Gynecol. 2015 Feb;125(2):414-423. doi: 10.1097/AOG.0000000000000631.
To evaluate the performance of simultaneous endometrial aspiration at the time of sonohysterography for screening postmenopausal women at risk for endometrial cancer.
A retrospective cohort study of women older than 50 years who underwent saline-infusion sonohysterography for the evaluation of their endometrium. On completion of imaging, the remaining intracavitary saline and endometrial tissue were aspirated through the saline-infusion sonohysterography catheter and submitted for pathologic evaluation. Based on the clinical, pathologic, and ultrasonographic results, the patients underwent surgical treatment with hysteroscopy, hysterectomy, or clinical observation. Follow-up results and outcomes were collected using electronic medical records. Sensitivity, specificity, and predictive values of saline-infusion sonohysterography, endometrial aspiration, and combined approaches for endometrial aspiration and sonohysterography were assessed.
Six hundred three patients underwent endometrial aspiration at the time of sonohysterography. Endometrial tissue was present in 567 (94.0%) and outcome data were available for 540 (89.5%). In 194 (35.9%) patients, final pathology was obtained by surgical intervention. The remaining 346 (64.1%) patients were monitored for at least 6 months. Thirty patients (5.6%) had cancer or endometrial hyperplasia. A sequential model, in which endometrial aspiration was done only for positive saline-infusion sonohysterography findings, yielded sensitivity of 86.7% (95% confidence interval [CI] 69-96%) and specificity of 100% (95% CI 99-100%) for detecting endometrial hyperplasia or cancer (area under the curve 0.93). Considering proliferative endometrium as abnormal endometrial aspiration reduced specificity to 88.3% (95% CI 85-91%, P<.01) without significant increase in sensitivity (100%, 95% CI 88-100%, P=.13).
The high sensitivity and specificity of the sequential endometrial aspiration at the time of sonohysterography make this approach a useful and reliable screening algorithm for detecting endometrial cancer or hyperplasia in postmenopausal women at risk. Endometrial aspiration at the time of sonohysterography should be considered as an initial one-stop endometrial evaluation in this population.
评估在子宫超声造影时同步进行子宫内膜抽吸术对筛查有子宫内膜癌风险的绝经后女性的效能。
对50岁以上接受生理盐水灌注子宫超声造影以评估其子宫内膜的女性进行一项回顾性队列研究。成像完成后，通过生理盐水灌注子宫超声造影导管抽吸剩余的宫腔内生理盐水和子宫内膜组织，并进行病理评估。根据临床、病理和超声检查结果，患者接受宫腔镜手术、子宫切除术或临床观察。使用电子病历收集随访结果和结局。评估生理盐水灌注子宫超声造影、子宫内膜抽吸术以及子宫内膜抽吸术与子宫超声造影联合方法的敏感性、特异性和预测值。
603例患者在子宫超声造影时进行了子宫内膜抽吸术。567例（94.0%）存在子宫内膜组织，540例（89.5%）可获得结局数据。194例（35.9%）患者通过手术干预获得最终病理结果。其余346例（64.1%）患者接受了至少6个月的监测。30例（5.6%）患有癌症或子宫内膜增生。一种序贯模型，即仅对生理盐水灌注子宫超声造影结果阳性的患者进行子宫内膜抽吸术，检测子宫内膜增生或癌症的敏感性为86.7%（95%置信区间[CI]69 - 96%），特异性为100%（95%CI 99 - 100%）（曲线下面积0.93）。将增殖期子宫内膜视为异常子宫内膜抽吸会使特异性降至88.3%（95%CI 85 - 91%，P <.01），而敏感性无显著增加（100%，95%CI 88 - 100%，P =.13）。
子宫超声造影时序贯子宫内膜抽吸术的高敏感性和特异性使其成为检测有风险的绝经后女性子宫内膜癌或增生的一种有用且可靠的筛查算法。子宫超声造影时的子宫内膜抽吸术应被视为该人群初步的一站式子宫内膜评估方法。
