Wen Xiaoduo, Tian Haiyan, Yan Xiaojing, Sun Quiqing, Du Yuanyuan, Wen Denggui, Yang Yi
Department of Ultrasound in Obstetrics and Gynecology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Medical Statistics, Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Front Med (Lausanne). 2021 Oct 27;8:727711. doi: 10.3389/fmed.2021.727711. eCollection 2021.
To evaluate whether the combined measurement of pelvic organ mobility and levator hiatus area improves the sensitivity of transperineal ultrasound (the index test) for diagnosing pelvic organ prolapse (POP). We retrospectively recruited women who had been examined in a tertiary gynecological center for symptoms of lower urinary tract incontinence and/or POP between January 2017 and June 2018. We excluded patients who had undergone hysterectomy previously or those who had received corrective surgery. All subjects underwent a standardized interview, POP quantification (POP-Q) examination (a reference standard for patients and controls), and ultrasound measurements of the levator hiatus area at rest (rHA), on contraction (cHA), and on Valsalva (vHA). We also determined the mobility of the bladder neck (BNM), cervix (CM), and rectum ampulla (RAM). Receiver operating characteristic (ROC) curve analyses were performed to determine cut-off values for diagnosis. Diagnostic performance was assessed by sensitivity, specificity, and area under curve (AUC). A total of 343 women were eligible for analysis, including 247 POP patients (stage 2-3 by POP-Q) and 96 controls. Compared with controls, POP cases had significantly higher values for rHA, vHA, cHA, BNM, CM, and RAM. Each parameter was identified as a significant discriminator for POP and controls, as determined by ROC curve analysis, although the cut-off value varied slightly between different parameters. The combination of rHA, vHA, and cHA (with any HA that was ≥ the cut-off) improved the sensitivity from 64-89 to 89-93%. The combination of pelvic organ mobility with rHA, vHA, and cHA, further increased the sensitivity from 89-93 to 95-97%. The combination of levator hiatus area and pelvic organ mobility improved the sensitivity of transperineal ultrasound in the diagnosis of POP, whether used as a frontline test to assist POP-Q grading or to monitor the effect of pelvic floor exercise programs.
评估盆腔器官活动度和提肛裂孔面积的联合测量是否能提高经会阴超声（指标检测）诊断盆腔器官脱垂（POP）的敏感性。我们回顾性招募了2017年1月至2018年6月期间在一家三级妇科中心因下尿路失禁症状和/或盆腔器官脱垂接受检查的女性。我们排除了先前接受过子宫切除术的患者或接受过矫正手术的患者。所有受试者均接受了标准化访谈、盆腔器官脱垂定量（POP-Q）检查（患者和对照的参考标准），以及静息时（rHA）、收缩时（cHA）和瓦尔萨尔瓦动作时（vHA）提肛裂孔面积的超声测量。我们还测定了膀胱颈（BNM）、宫颈（CM）和直肠壶腹（RAM）的活动度。进行受试者操作特征（ROC）曲线分析以确定诊断的临界值。通过敏感性、特异性和曲线下面积（AUC）评估诊断性能。共有343名女性符合分析条件，包括247例盆腔器官脱垂患者（根据POP-Q为2-3期）和96名对照。与对照组相比，盆腔器官脱垂病例的rHA、vHA、cHA、BNM、CM和RAM值显著更高。如ROC曲线分析所确定，每个参数均被确定为盆腔器官脱垂和对照的显著鉴别指标，尽管不同参数之间的临界值略有差异。rHA、vHA和cHA的联合（任何HA≥临界值）使敏感性从64%-89%提高到89%-93%。盆腔器官活动度与rHA、vHA和cHA的联合，进一步将敏感性从89%-93%提高到95%-97%。提肛裂孔面积和盆腔器官活动度的联合提高了经会阴超声在诊断盆腔器官脱垂中的敏感性，无论是用作辅助POP-Q分级的一线检测还是监测盆底锻炼计划的效果。
