Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Dr. Kho).
Department of Obstetrics, Gynecology & Reproductive Sciences (Drs. Desai, Schwartz, and Xu); CooperSurgical Inc., Trumbull (Dr. Desai), Connecticut.
J Minim Invasive Gynecol. 2022 Jan;29(1):119-127. doi: 10.1016/j.jmig.2021.07.004. Epub 2021 Jul 13.
To examine the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identify factors associated with missed diagnosis, and compare the outcomes of patients who had a preoperative diagnosis with those of patients who had a missed diagnosis.
Retrospective cohort study using linked data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry from 2003 to 2015.
Inpatient and outpatient encounters at civilian hospitals and ambulatory surgery centers in New York State.
Women with uterine leiomyosarcoma who underwent a hysterectomy and a preoperative endometrial sampling within 90 days before the hysterectomy.
Endometrial sampling.
A total of 79 patients with uterine leiomyosarcoma met the sample eligibility criteria. Of these patients, 46 (58.2%) were diagnosed preoperatively, and 33 (41.8%) were diagnosed postoperatively. Patients in the 2 groups did not differ significantly in age, race/ethnicity, bleeding symptoms, or comorbidities assessed. In multivariable regression analysis, women who had endometrial sampling performed with hysteroscopy (compared with women who had endeometrial sampling performed without hysteroscopy) had a higher likelihood of preoperative diagnosis (adjusted risk ratio [aRR] 3.03; 95% confidence interval [CI], 1.43-6.42). Patients with localized stage (vs distant stage) or tumor size >11 cm (vs <8 cm) were less likely to be diagnosed preoperatively (aRR 0.50; 95% CI, 0.28-0.89, and aRR 0.54; 95% CI, 0.30-0.99, respectively). Supracervical hysterectomy was not performed in any of the patients whose leiomyosarcoma was diagnosed preoperatively compared with 21.2% of the patients who were diagnosed postoperatively (p = .002).
Endometrial sampling detected leiomyosarcoma preoperatively in 58.2% of the patients. The use of hysteroscopy with endometrial sampling improved preoperative detection of leiomyosarcoma by threefold. Patients with a missed diagnosis had a higher risk of undergoing suboptimal surgical management at the time of their index surgery.
检查子宫内膜取样在接受子宫切除术的女性中术前检测子宫平滑肌肉瘤的有效性，确定与漏诊相关的因素，并比较术前诊断患者和漏诊患者的结局。
使用 2003 年至 2015 年纽约州规划与研究合作系统和纽约州癌症登记处的关联数据进行回顾性队列研究。
在纽约州的民用医院和门诊手术中心进行住院和门诊就诊。
接受子宫切除术且在子宫切除术前 90 天内进行子宫内膜取样的患有子宫平滑肌肉瘤的女性。
子宫内膜取样。
共有 79 名符合子宫平滑肌肉瘤样本入选标准的患者。其中，46 名（58.2%）患者术前诊断，33 名（41.8%）患者术后诊断。两组患者在年龄、种族/族裔、出血症状或评估的合并症方面无显著差异。在多变量回归分析中，接受宫腔镜下子宫内膜取样的女性（与未接受宫腔镜下子宫内膜取样的女性相比）术前诊断的可能性更高（调整风险比[aRR] 3.03；95%置信区间[CI]，1.43-6.42）。局部分期（远处分期）或肿瘤大小>11cm（<8cm）的患者术前诊断的可能性较低（aRR 0.50；95%CI，0.28-0.89，和 aRR 0.54；95%CI，0.30-0.99）。与术后诊断的患者相比，所有术前诊断为平滑肌肉瘤的患者均未行经宫颈子宫切除术，而术后诊断的患者中有 21.2%行经宫颈子宫切除术（p=0.002）。
子宫内膜取样术术前诊断出 58.2%的患者患有平滑肌肉瘤。宫腔镜联合子宫内膜取样术可将平滑肌肉瘤的术前检出率提高三倍。漏诊患者在其指数手术时接受次优手术治疗的风险更高。
