Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.
Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.
J Gynecol Obstet Hum Reprod. 2020 Apr;49(4):101696. doi: 10.1016/j.jogoh.2020.101696. Epub 2020 Feb 1.
To investigate the diagnostic and therapeutic efficiency of dilatation-curettage (D&C) combined with aspiration curettage for endometrial pathology compared to hysteroscopy alone in this study.
A total of 143 patients who have suspicion of endometrial mass like lesion, increased endometrial thickness (>5-mm at menopause and/or endometrial thickness upper than 5-mm in patients under tamoxifen treatment due to breast cancer during 2-D transvaginal ultrasonography examination) were enrolled. All patients underwent procedures in order of hysteroscopy, D&C plus aspiration and second look hysteroscopy. Data for age, menopausal status, tamoxifen treatment, endometrial histology, hysteroscopy and D&C findings were recorded and statistically analyzed.
Initial hysteroscopy revealed focally growing endometrial lesion in 96 patients. Second look hysteroscopy showed persistent focal lesion in 77 patients (80 %) after D&C plus aspiration. Endometrial blind curettage failed to diagnose 42 % (25/60) of endometrial polyps, none of submucous myomas as well as 27 % (3/11) of premalignant and malignant endometrial lesions. The sensitivity, specificity, overall accuracy, positive predictive value and negative predictive value of hysteroscopy were found as 84.1 %, 83.3 %, 83.9 %, 93.8 %, and 63.8 %, respectively.
Hysteroscopy showed significant superiority in the diagnosis and definitive treatment of endometrial pathologies specifically in focally growing endometrial lesions compared to D&C plus aspiration.
本研究旨在探讨与单纯宫腔镜检查相比，刮宫术（D&C）联合吸引刮宫术治疗子宫内膜病变的诊断和治疗效果。
共纳入 143 例经 2 维经阴道超声检查怀疑有子宫内膜肿块样病变、子宫内膜增厚（绝经后>5mm 或因乳腺癌正在接受他莫昔芬治疗的患者子宫内膜厚度>5mm）的患者。所有患者均按宫腔镜检查、D&C 联合吸引刮宫术和再次宫腔镜检查的顺序进行检查。记录患者的年龄、绝经状态、他莫昔芬治疗、子宫内膜组织学、宫腔镜和 D&C 检查结果，并进行统计学分析。
初始宫腔镜检查显示 96 例患者存在局灶性子宫内膜病变。D&C 联合吸引刮宫术后，77 例（80%）患者仍存在局灶性病变。子宫内膜盲刮未能诊断 42%（25/60）的子宫内膜息肉、无一例黏膜下肌瘤以及 27%（3/11）的癌前病变和恶性子宫内膜病变。宫腔镜检查的敏感性、特异性、总准确性、阳性预测值和阴性预测值分别为 84.1%、83.3%、83.9%、93.8%和 63.8%。
与 D&C 联合吸引刮宫术相比，宫腔镜检查在诊断和治疗局灶性子宫内膜病变方面具有明显优势。
