Harika Bhukya, Subbaiah Murali, Maurya Dilip Kumar
Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India.
J Midlife Health. 2021 Jul-Sep;12(3):206-210. doi: 10.4103/jmh.jmh_246_20. Epub 2021 Oct 16.
The aim of this study was to determine the diagnostic accuracy of a hysteroscopic scoring system in predicting endometrial cancer and endometrial hyperplasia with atypia.
This is a prospective study involving 95 peri and postmenopausal women with abnormal uterine bleeding who underwent hysteroscopic-guided endometrial biopsy. After the calculation of hysteroscopic score, biopsy was obtained and sent for histopathological examination. Hysteroscopic diagnosis of carcinoma endometrium was made when the total score was ≥16 and a score ≥7 supported a diagnosis of endometrial hyperplasia with atypia.
Out of the 95 women, 46 (48.4%) women had postmenopausal bleeding. The mean age of women was 50.4 ± 10.3 years. Eight women were diagnosed to have endometrial cancer and eight had endometrial hyperplasia with atypia on histopathological examination. Using a hysteroscopy score ≥16, the sensitivity and specificity were found to be 62.5% and 90.8%, respectively, for diagnosing endometrial cancer. Hysteroscopy score ≥9 was found to be a better cutoff for diagnosing endometrial cancer using Youden index. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing endometrial cancer with score ≥9 was 100%, 67.8%, 22.2%, and 100%, respectively. The sensitivity, specificity, PPV, and NPV for diagnosing endometrial hyperplasia with atypia with score ≥7 was found to be 75%, 58.6%, 14.3%, and 96.2%, respectively.
The hysteroscopic scoring system has a good diagnostic performance when a cutoff score ≥9 is used in predicting endometrial cancer. However, the scoring system has lower diagnostic accuracy in predicting endometrial hyperplasia with atypia.
本研究的目的是确定宫腔镜评分系统在预测子宫内膜癌和非典型子宫内膜增生方面的诊断准确性。
这是一项前瞻性研究，纳入了95例有异常子宫出血的围绝经期和绝经后妇女，她们均接受了宫腔镜引导下的子宫内膜活检。计算宫腔镜评分后，获取活检组织并送去做组织病理学检查。当总分≥16时诊断为子宫内膜癌，评分≥7支持非典型子宫内膜增生的诊断。
95例妇女中，46例（48.4%）有绝经后出血。妇女的平均年龄为50.4±10.3岁。组织病理学检查发现8例妇女患有子宫内膜癌，8例患有非典型子宫内膜增生。使用宫腔镜评分≥16诊断子宫内膜癌时，敏感性和特异性分别为62.5%和90.8%。使用约登指数发现，宫腔镜评分≥9是诊断子宫内膜癌的更佳截断值。评分≥9诊断子宫内膜癌的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为100%、67.8%、22.2%和100%。评分≥7诊断非典型子宫内膜增生的敏感性、特异性、PPV和NPV分别为75%、58.6%、14.3%和96.2%。
当使用≥9的截断评分预测子宫内膜癌时，宫腔镜评分系统具有良好的诊断性能。然而，该评分系统在预测非典型子宫内膜增生方面的诊断准确性较低。
