Department of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, Massachusetts (all authors)..
Department of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, Massachusetts (all authors).
J Minim Invasive Gynecol. 2020 Feb;27(2):344-351. doi: 10.1016/j.jmig.2019.09.001. Epub 2019 Sep 6.
Evaluate the accuracy of tissue sampling techniques for the diagnosis of adenomyosis.
Systematic Review via MEDLINE and the Cochrane Library searches.
Review performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing MeSH terms and keywords including "Adenomyosis/diagnosis" or "Adenomyosis/pathology" or "Myometrium/pathology" and "Biopsy" or "Hysteroscopy" or "Laparoscopy." Articles initially screened by title and abstract to include relevant studies with reference lists cross-referenced to find additional studies. Articles related to the diagnosis of uterine malignancy or studies in which tissue sampling was obtained through excisional surgical procedures were excluded from the review.
TABULATION, INTEGRATION, AND RESULTS: Fourteen studies were identified describing tissue sampling techniques to diagnose adenomyosis, with a total of 1909 patients, from 12 different countries, involving 6 different continents. Tissue sampling techniques were categorized based on (1) biopsy approach as either intrauterine and extrauterine and (2) techniques that were validated or not validated with a confirmatory hysterectomy pathology. Overall, there was significant heterogeneity in the tissue sampling techniques including intrauterine sampling obtained through hysteroscopic biopsy or resection and extrauterine tissue sampling obtained with needle biopsy by a percutaneous, transvaginal, laparoscopic, or ex-vivo approach. Sensitivity of these techniques varied significantly based on technique, tissue sampling location and the number of biopsies obtained, and was as low as 22.2% for an ultrasound-guided transvaginal biopsy of suspicious uterine lesions (4 biopsies per patient) and was as high as 97.8% for a laparoscopic guided myometrial biopsy of suspicious uterine lesions (10 biopsies per patient). Specificity for the identified tissue sampling techniques was more homogeneous ranging from 78.5% to 100% for all methods identified. The positive predictive value and negative predictive value ranges were 75.9% to 100% and 46.4% to 80% respectively among all tissue sampling techniques identified with confirmatory hysterectomy pathology.
Because of the heterogeneity of the tissue sampling techniques, diverse patient populations, and significant conflicting recommendations, no conclusive recommendation on the optimal tissue sampling technique can be made. However, it would be reasonable to limit uterine tissue sampling for confirmatory diagnosis of adenomyosis in patients with a suspicion of adenomyosis based on both symptom profile and pelvic ultrasound, where a planned diagnostic laparoscopy for either infertility or pelvic pain has already been contemplated and scheduled, and where the confirmatory results may be of clinical benefit in discussing the prognosis of recurrent postoperative symptoms and guide any future treatment recommendations.
评估用于诊断子宫腺肌病的组织取样技术的准确性。
通过 MEDLINE 和 Cochrane 图书馆检索进行系统评价。
利用系统评价和荟萃分析的首选报告项目指南进行综述，使用 MeSH 术语和关键词，包括“adenomyosis/diagnosis”或“adenomyosis/pathology”或“myometrium/pathology”和“biopsy”或“hysteroscopy”或“laparoscopy”。根据标题和摘要初步筛选出相关研究，并参考交叉引用的参考文献以找到其他研究。排除了与子宫恶性肿瘤诊断相关的研究或组织取样通过切除性手术获得的研究。
表格、综合和结果：共确定了 14 项描述用于诊断子宫腺肌病的组织取样技术的研究，涉及来自 12 个不同国家的 1909 名患者，涉及 6 个不同的大洲。组织取样技术根据（1）活检方法分为宫内和宫外，以及（2）是否通过确认性子宫切除术病理验证的技术进行分类。总体而言，组织取样技术存在显著的异质性，包括通过宫腔镜活检或切除获得的宫内取样和通过经皮、经阴道、腹腔镜或离体途径获得的宫外组织取样。这些技术的敏感性根据技术、组织取样位置和获得的活检数量而有很大差异，经阴道超声引导可疑子宫病变活检的敏感性低至 22.2%（每个患者 4 个活检），经腹腔镜引导可疑子宫病变的肌层活检的敏感性高至 97.8%（每个患者 10 个活检）。所有鉴定组织取样技术的特异性更为一致，范围为 78.5%至 100%。所有经确认性子宫切除术病理鉴定的组织取样技术的阳性预测值和阴性预测值范围分别为 75.9%至 100%和 46.4%至 80%。
由于组织取样技术的异质性、不同的患者人群以及相互矛盾的推荐意见，因此无法对最佳组织取样技术做出明确的推荐。然而，如果已经考虑并计划进行诊断性腹腔镜检查以治疗不孕或盆腔疼痛，并且可以从确认性结果中获得临床益处，以讨论复发性术后症状的预后并指导任何未来的治疗建议，那么基于症状谱和盆腔超声检查对可疑子宫腺肌病患者进行子宫组织取样以确认诊断可能是合理的。
