Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, Naples, Italy.
Gynecology and Obstetrics Unit, Department of Public Health, University of Naples Federico II, Naples, Italy.
Gynecol Oncol. 2020 Aug;158(2):347-353. doi: 10.1016/j.ygyno.2020.05.012. Epub 2020 May 25.
To investigate the diagnostic accuracy of endometrial biopsy performed with hysteroscopic direct visualization using the "grasp technique" for the detection of endometrial carcinoma (EC) histology type and tumor grade.
A cross-sectional study including the clinical and pathology records of patients with confirmed EC who underwent definitive surgery at University of Naples was performed. The preoperative diagnosis of endometrial tumor type and grade obtained using the hysteroscopy grasp technique was correlated with the final pathology specimens. Those results were compared to the diagnostic accuracy of the biopsies collected in a cohort of patients who underwent preoperative diagnostic hysteroscopy followed by blind endometrial biopsy using the Novak curette with subsequent surgical definitive treatment at University of Pisa. Statistical analysis was based on frequency data and diagnostic agreement of the pathology results.
A total of 129 patients were included in the final analysis. An agreement rate of 104/106 (98.1%) for endometrioid type and 15/23 (65.2%) for non-endometrioid type was obtained between preoperative hysteroscopic grasp endometrial biopsy specimens and the final pathology with a coefficient k for G1, G2 and G3 tumors of 0.928, 0.925 and 0.974, respectively. When compared to 121 patients undergoing preoperative blind Novak endometrial biopsy, the hysteroscopic grasp technique was superior in agreement rates for tumor histotype [diagnostic accuracy (0.922 vs 0.890); K value (0.705 vs 0.642)] and grade when in presence of endometrioid type EC (K Cohen 0.354 for G1, 0.263 for G2 and 0.488 for G3).
Preoperative hysteroscopic guided "grasp" endometrial biopsy provides a more accurate diagnosis of EC histology type and tumor grade when in presence of endometrioid type tumor compared to blind endometrial biopsy obtained using the Novak curette.
研究在直视宫腔镜下采用“抓取技术”进行子宫内膜活检，以检测子宫内膜癌（EC）组织学类型和肿瘤分级的诊断准确性。
对在那不勒斯大学接受确定性手术的确诊 EC 患者的临床和病理记录进行了一项横断面研究。采用宫腔镜抓取技术术前诊断的子宫内膜肿瘤类型和分级与最终病理标本进行相关性分析。将这些结果与在比萨大学进行术前诊断性宫腔镜检查后采用 Novak 刮匙进行盲式子宫内膜活检并随后进行确定性手术治疗的患者队列中的活检诊断准确性进行比较。统计分析基于频率数据和病理结果的诊断一致性。
共有 129 例患者纳入最终分析。术前宫腔镜抓取子宫内膜活检标本与最终病理结果的一致性率分别为内胚层型 104/106（98.1%）和非内胚层型 15/23（65.2%），G1、G2 和 G3 肿瘤的 K 系数分别为 0.928、0.925 和 0.974。与 121 例行术前盲式 Novak 子宫内膜活检的患者相比，在存在内胚层型 EC 时，宫腔镜抓取技术在肿瘤组织类型的一致性率方面更具优势[诊断准确性（0.922 比 0.890）；K 值（0.705 比 0.642）]和分级（K 科恩 0.354 用于 G1，0.263 用于 G2，0.488 用于 G3）。
与采用 Novak 刮匙进行盲式子宫内膜活检相比，在存在内胚层型肿瘤时，术前宫腔镜引导下的“抓取”子宫内膜活检可更准确地诊断 EC 的组织学类型和肿瘤分级。
