Department of Obstetrics and Gynecology, Maastricht UMC+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
Department of Gynecology and Obstetrics, Maxima Medisch Centrum, Veldhoven, The Netherlands.
Ultrasound Obstet Gynecol. 2019 Jul;54(1):28-34. doi: 10.1002/uog.20229. Epub 2019 Jun 12.
In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding.
In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver-operating characteristics (HSROC) model and HSROC curves were plotted.
After selection and quality assessment, five studies were included. Using 'polyps diagnosed with histopathology' as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6-100%) and the pooled specificity was 91.1% (95% CI, 63.2-100%). Using 'polyps seen on hysteroscopy' as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9-100%) and the pooled specificity was 84.5% (95% CI, 68.1-100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8-100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81-98%.
Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
在绝经后出血的女性中，子宫内膜息肉是一种常见的发现，息肉内存在局灶性（前）恶性肿瘤的风险高达 6%。由于这种报道的风险，最好通过微创方法检测这些女性中的息肉，这一点很重要。本系统评价的目的是评估盐水对比超声造影（SCSH）在诊断绝经后出血女性子宫内膜息肉中的准确性。
2018 年 8 月，对 MEDLINE、EMBASE 和 Web of Science 数据库进行了电子检索，以确定所有使用 SCSH 检测绝经后妇女子宫内膜息肉的诊断研究。如果 SCSH 用于检测绝经后出血妇女的子宫内膜息肉，并且使用宫腔镜下息肉检出或组织病理学诊断作为参考标准，则将研究纳入。两位评审员使用诊断准确性研究质量评估工具（QUADAS-2）评估方法学质量。对于每个参考标准，分别进行了两次分析。使用层次总结受试者工作特征（HSROC）模型计算了汇总敏感性和特异性，并绘制了 HSROC 曲线。
经过选择和质量评估，共纳入了 5 项研究。使用“组织病理学诊断的息肉”作为参考标准时，SCSH 的汇总敏感性为 86.5%（95%CI，63.6-100%），特异性为 91.1%（95%CI，63.2-100%）。使用“宫腔镜下可见的息肉”作为参考标准时，SCSH 的汇总敏感性为 85.1%（95%CI，66.9-100%），特异性为 84.5%（95%CI，68.1-100%）。排除了一项报告 SCSH 检查结果不佳的研究后，使用宫腔镜作为参考标准时，SCSH 的汇总敏感性提高至 90.7%（95%CI，72.8-100%）。两项研究报告的宫腔镜检测息肉的敏感性为 81%-98%。
如果 SCSH 检查质量理想，则可以将其视为一种方法，用于对绝经后出血的女性进行分层，以进行进一步的诊断性检查和宫腔镜治疗。在 SCSH 无息肉样病变且子宫内膜样本良性的女性中，应考虑期待治疗。版权所有©2019ISUOG。由 John Wiley & Sons Ltd 出版。
