Zhang Guo, Wang Yue, Liang Xu-Dong, Zhou Rong, Sun Xiu-Li, Wang Jian-Liu, Wei Li-Hui
Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing 100044, China.
Chin Med J (Engl). 2020 Sep 30;134(2):193-199. doi: 10.1097/CM9.0000000000001109.
Endometrial cancer is one of the most common malignancies of the reproductive system. Effective and cost-effective screening method for populations at high risk is not available. This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.
A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included. Microscale endometrial sampling biopsy was performed, followed by hysteroscopic endometrial biopsy. We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling. Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed, and the medical costs of the two procedures were compared.
The specimen adequacy was 81.2%. Patient age, menopausal status, endometrial thickness, and endometrial lesion type were correlated with specimen adequacy. There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy (kappa 0.950, 95% CI 0.925-0.975). The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy were 91.7%, 100.0%, 100.0%, and 99.3% for endometrial cancer screening, respectively, and 82.0%, 100.0%, 100.0%, and 99.4% for atypical hyperplasia screening. The medical cost of endometrial sampling biopsy was only 22.1% of the cost of hysteroscopic biopsy.
Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination. It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.
子宫内膜癌是生殖系统最常见的恶性肿瘤之一。目前尚无针对高危人群的有效且具有成本效益的筛查方法。本研究旨在探讨微尺度子宫内膜采样活检的标本充足率及其影响因素，并与宫腔镜子宫内膜活检相比，评估活检在子宫内膜癌和非典型增生筛查中的诊断准确性及医疗成本。
纳入2017年11月至2018年8月期间共1551例需要进行宫腔镜子宫内膜活检的子宫内膜病变高危患者。先进行微尺度子宫内膜采样活检，随后进行宫腔镜子宫内膜活检。我们评估了微尺度子宫内膜采样的标本充足率及其影响因素。评估微尺度子宫内膜采样活检与宫腔镜子宫内膜活检之间的诊断一致性。分析微尺度子宫内膜采样活检在筛查子宫内膜癌和非典型增生中的敏感性、特异性、阳性预测值和阴性预测值，并比较两种检查方法的医疗成本。
标本充足率为81.2%。患者年龄、绝经状态、子宫内膜厚度和子宫内膜病变类型与标本充足率相关。微尺度子宫内膜采样活检与宫腔镜活检在鉴别子宫内膜良性和恶性疾病方面具有良好的一致性（kappa值为0.950，95%可信区间为0.925 - 0.975）。微尺度子宫内膜采样活检在子宫内膜癌筛查中的敏感性、特异性、阳性预测值和阴性预测值分别为91.7%、100.0%、100.0%和99.3%，在非典型增生筛查中分别为82.0%、100.0%、100.0%和99.4%。子宫内膜采样活检的医疗成本仅为宫腔镜活检成本的22.1%。
微尺度子宫内膜采样活检是一种微创替代技术，可获取足够的子宫内膜标本用于组织病理学检查。它有潜力以高效、低成本的方式用于检测子宫内膜癌和非典型增生。
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