将超声检查和子宫内膜吸取术相结合作为子宫内膜肿瘤的一站式筛查。

Combining Ultrasonography and Endometrial Aspiration as a One-Stop Screening for Endometrial Neoplasia.

机构信息

Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, the Department of Obstetrics & Gynecology and Gynecologic Oncology, LIJ Medical Center, Northwell Health, New Hyde Park, and the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York; the Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford, California; the Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; and the Department of Obstetrics and Gynecology, University Hospital Leuven, and the Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

出版信息

Obstet Gynecol. 2024 Dec 1;144(6):801-809. doi: 10.1097/AOG.0000000000005752. Epub 2024 Oct 10.

DOI:10.1097/AOG.0000000000005752

PMID:39388701

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11556823/

Abstract

OBJECTIVE

To assess the performance of simultaneous endometrial aspiration and sonohysterography to screen for endometrial cancer or hyperplasia in women aged 50 years or older.

METHODS

We conducted a prospective study from February 2014 to October 2020 at the ultrasound unit of a large urban academic medical center. The study included 1,635 women aged 50 years or older referred for endometrial evaluation, with follow-up through January 2021. Participants underwent saline infusion sonohysterography combined with ultrasound-guided endometrial aspiration. The primary outcome measured was a diagnosis of endometrial cancer or hyperplasia within 1 year from screening. The diagnostic accuracy of the combined evaluation method, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed.

RESULTS

Of 1,170 women who completed the study protocol, 82 (7.0%) had endometrial cancer and 42 (3.6%) had endometrial hyperplasia. Of all patients who developed cancer during the follow-up period, 85.5% were diagnosed within 1 year after evaluation. The application of simultaneous endometrial aspiration and sonohysterography together demonstrated a sensitivity of 99.1%, specificity of 24.9%, PPV of 11.8%, and NPV of 99.6%. Using a theoretical sequential approach, assuming an endometrial aspiration is performed only in patients determined to be high risk by sonohysterography, demonstrated a sensitivity of 93.4%, specificity of 99.9%, PPV of 99.0%, and NPV of 99.3%.

CONCLUSION

Simultaneous endometrial aspiration and sonohysterography is an effective one-stop outpatient screening tool for detecting endometrial cancer and hyperplasia in women aged 50 years or older. With the integration of two screening modalities into a single procedure, simultaneous endometrial aspiration and sonohysterography may overcome the limitations inherent in each of the currently recommended methods individually, potentially improving patient prognosis and streamlining the diagnostic process.

摘要

目的

评估 50 岁及以上女性同时进行子宫内膜抽吸和经阴道超声检查（sonohysterography）以筛查子宫内膜癌或增生的性能。

方法

我们于 2014 年 2 月至 2020 年 10 月在一家大型城市学术医疗中心的超声科进行了一项前瞻性研究。该研究纳入了 1635 名 50 岁及以上因子宫内膜评估而就诊的女性，随访至 2021 年 1 月。参与者接受了生理盐水灌注经阴道超声检查联合超声引导下子宫内膜抽吸。主要结局是在筛查后 1 年内诊断为子宫内膜癌或增生。评估了联合评估方法的诊断准确性，包括灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

在完成研究方案的 1170 名女性中，有 82 名（7.0%）患有子宫内膜癌，42 名（3.6%）患有子宫内膜增生。在随访期间发生癌症的所有患者中，85.5%在评估后 1 年内被诊断。同时进行子宫内膜抽吸和经阴道超声检查的应用显示出 99.1%的灵敏度、24.9%的特异性、11.8%的阳性预测值和 99.6%的阴性预测值。采用理论序贯方法，假设仅对经阴道超声检查确定为高危的患者进行子宫内膜抽吸，灵敏度为 93.4%，特异性为 99.9%，阳性预测值为 99.0%，阴性预测值为 99.3%。