Ferrando Cecile A, Lintel M Kate, Bradley Linda D
Obstetrics, Gynecology & Women's Health Institute; Cleveland Clinic, Cleveland, OH 44195, United States.
Obstetrics, Gynecology & Women's Health Institute; Cleveland Clinic, Cleveland, OH 44195, United States.
J Gynecol Obstet Hum Reprod. 2023 Dec;52(10):102685. doi: 10.1016/j.jogoh.2023.102685. Epub 2023 Oct 22.
To compare pathology results after office-based blind endometrial biopsy and pathology results from hysteroscopy in women presenting with abnormal uterine bleeding (AUB).
A retrospective cohort study of biologic women presenting with AUB at a tertiary care referral care center. Patients were included if they underwent evaluation with blind endometrial biopsy performed in the office followed by hysteroscopy within one year. Hysteroscopic findings and pathology were correlated with index endometrial biopsy findings.
689 patients met inclusion criteria. The mean age and BMI were 49 (±10) years and 31 (±8) kg/m. The median duration of bleeding leading up to presentation was of 3.5 (1.5-9) months. Of the patients who had operative hysteroscopic pathology demonstrating endometrial polyp, 30.6 % (81) had a polyp detected on office endometrial biopsy. Of the patients who had hysteroscopic pathology demonstrating intracavitary fibroids, 0 % (0) were detected on endometrial biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6 % (4) were detected or suspected on endometrial biopsy. Of the patients who had hyperplasia with atypia on hysteroscopy, 5.9 % (1) were detected or suspected on endometrial biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopy, of which 8.3 % (1) were detected on endometrial biopsy.
Concordance between focal findings on office hysteroscopy and endometrial biopsy is low. Endometrial biopsy when malignancy is suspected has been shown to be of benefit, but in the setting of suspected benign focal pathology, blind assessment of the endometrial cavity for definitive diagnosis should be abandoned. In women with symptomatic uterine bleeding, hysteroscopic visualization is associated with increased sensitivity in identifying intrauterine pathology.
比较门诊盲刮子宫内膜活检的病理结果与宫腔镜检查在子宫异常出血（AUB）女性中的病理结果。
在一家三级医疗转诊中心对患有AUB的生物学女性进行回顾性队列研究。如果患者在门诊接受了盲刮子宫内膜活检评估，并在一年内接受了宫腔镜检查，则纳入研究。将宫腔镜检查结果和病理与索引子宫内膜活检结果进行关联。
689例患者符合纳入标准。平均年龄和BMI分别为49（±10）岁和31（±8）kg/m²。就诊前出血的中位持续时间为3.5（1.5 - 9）个月。在宫腔镜手术病理显示为子宫内膜息肉的患者中，30.6%（81例）在门诊子宫内膜活检中检测到息肉。在宫腔镜病理显示为宫腔内肌瘤的患者中，0%（0例）在子宫内膜活检中被检测到。在宫腔镜检查显示为无 atypia 的增生患者中，28.6%（4例）在子宫内膜活检中被检测到或疑似。在宫腔镜检查显示为有 atypia 的增生患者中，5.9%（1例）在子宫内膜活检中被检测到或疑似。宫腔镜检查有12例确诊或疑似恶性肿瘤，其中8.3%（1例）在子宫内膜活检中被检测到。
门诊宫腔镜检查的局灶性发现与子宫内膜活检之间的一致性较低。当怀疑有恶性肿瘤时，子宫内膜活检已被证明是有益的，但在怀疑有良性局灶性病理的情况下，应放弃对子宫内膜腔进行盲法评估以进行明确诊断。在有症状性子宫出血的女性中，宫腔镜可视化在识别宫内病理方面具有更高的敏感性。
