Ueno Joji, Salgado Renato M, Tomioka Renato B, Colucci Juliana A, Schor Eduardo, Carvalho Filomena M
GERA-Institute of Reproductive Medicine, Sao Paulo, SP, Brazil,
Arch Gynecol Obstet. 2015 Aug;292(2):363-9. doi: 10.1007/s00404-015-3634-0. Epub 2015 Feb 3.
The aim of this retrospective observational study was to evaluate the reliability of diagnostic hysteroscopy, routinely performed along with endometrial biopsy, by analyzing and comparing both hysteroscopic and histopathological outcomes in asymptomatic infertile patients, previously to their IVF cycle.
The study included 84 consecutive infertile patients who underwent diagnostic hysteroscopy followed by endometrial biopsy. Four-micrometer sections were stained with hematoxylin and eosin and examined microscopically. The data evaluated the frequency and characteristics of endometrial abnormalities found in the biopsies of patients with normal hysteroscopy outcome. Descriptive data are presented as percentages, and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy for diagnosis of endometrial alterations were calculated on the basis of pathologic reports.
The hysteroscopy evaluation showed 50.0 % of patients with a normal uterine cavity, 40.5 % with endometrial polyps, 6.0 % with endometrial hyperemia, and 3.5 % with other endometrial abnormalities. Among the 42 patients with a normal uterine cavity at hysteroscopic examination, 60.0 % also had a normal biopsy outcome, but in other 40.0 % of patients at least one histopathological abnormal aspect was diagnosed at biopsy. The sensitivity (67.3 %), specificity (80.6 %), PPV (85.4 %) and NPV (59.5 %) of diagnostic hysteroscopy were calculated on the basis of histopathological findings.
Our results show that diagnostic hysteroscopy demonstrated intrauterine alterations in half of infertile patients; histopathological endometrial alterations suggest high rate of false-negative outcomes. Therefore, diagnostic hysteroscopy and concurrent endometrial biopsy should be used as complementary diagnostic and therapeutic approach, especially for patients with previous IVF failures.
这项回顾性观察研究的目的是，通过分析和比较无症状不育患者在体外受精周期前进行的诊断性宫腔镜检查和组织病理学检查结果，评估常规与子宫内膜活检同时进行的诊断性宫腔镜检查的可靠性。
该研究纳入了84例连续接受诊断性宫腔镜检查及随后子宫内膜活检的不育患者。对4微米厚的切片进行苏木精和伊红染色并进行显微镜检查。数据评估了宫腔镜检查结果正常的患者活检中发现的子宫内膜异常的频率和特征。描述性数据以百分比表示，并根据病理报告计算宫腔镜检查诊断子宫内膜改变的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
宫腔镜检查评估显示，50.0%的患者子宫腔正常，40.5%有子宫内膜息肉，6.0%有子宫内膜充血，3.5%有其他子宫内膜异常。在宫腔镜检查子宫腔正常的42例患者中，60.0%的患者活检结果也正常，但在其他40.0%的患者中，活检诊断出至少一个组织病理学异常方面。根据组织病理学结果计算诊断性宫腔镜检查的敏感性（67.3%）、特异性（80.6%）、PPV（85.4%）和NPV（59.5%）。
我们的结果表明，诊断性宫腔镜检查在一半的不育患者中发现了宫内改变；组织病理学子宫内膜改变提示假阴性结果发生率较高。因此，诊断性宫腔镜检查和同期子宫内膜活检应作为互补的诊断和治疗方法，特别是对于既往体外受精失败的患者。
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