Ashmore Ayisha A, Alao Abayomi I, Hibbard Amie, Burchnall Libbi, Menic Natalie, Abdul Summi, Asher Viren, Bali Anish, Kolhe Shilpa, Phillips Andrew
Derby Gynaecological Cancer Centre, Department of Gynaecology, University Hospitals of Derby and Burton NHS Foundation Trust (UHDB), Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
University of Nottingham, Nottingham, UK.
Arch Gynecol Obstet. 2025 Apr;311(4):1127-1132. doi: 10.1007/s00404-024-07922-3. Epub 2025 Jan 20.
To determine the rate of precancer and cancer in women presenting with PMB who have a visually atrophic endometrium at hysteroscopy and assess the value of endometrial biopsy in this situation and the adequacy of the samples obtained.
Retrospective reviews of all patients with a visually atrophic endometrium at hysteroscopy who had presented with PMB and had an ET > / = 4 mm or ET < 4 mm with focal changes or irregular features between 2013 and 2024 at University Hospitals of Derby and Burton were included (n = 1096). Patients who had previously had cancer or precancer or had unclear hysteroscopy findings were excluded. The endometrial biopsy histology result was considered the main outcome measure.
188 patients did not have a biopsy performed (17.15%), 660 patients had benign pathology (60.22%), and 239 patients had an inadequate sample result (21.81%). Nine patients had precancerous changes (0.82%). The rate of cancer was 0.00% (n = 0). The NPV of a visually atrophic endometrial cavity at hysteroscopy in detecting precancer or cancer was 99.2%. Patients with an ET < 4 mm pre-hysteroscopy and an atrophic endometrial cavity at hysteroscopy were 2.25 times more likely than those whose ET is > 4 mm to have an inadequate sample (p < 0.001, 95% CI 1.61-3.16). 10 patients who had an inadequate sample at initial biopsy had a repeat inadequate sample (n = 23, 43.48%).
The incidence of precancer/cancer in patients presenting with PMB with a visually atrophic endometrium at hysteroscopy is low. Many patients within this cohort have an inadequate sample at biopsy, and therefore, repeat sampling is of questionable value.
确定宫腔镜检查时子宫内膜视觉萎缩的绝经后阴道出血（PMB）女性的癌前病变和癌症发生率，并评估这种情况下子宫内膜活检的价值以及所取样本的充分性。
回顾性分析2013年至2024年在德比和伯顿大学医院因PMB就诊且宫腔镜检查显示子宫内膜视觉萎缩、子宫内膜厚度（ET）≥4mm或ET＜4mm但有局灶性改变或不规则特征的所有患者（n = 1096）。排除既往有癌症或癌前病变或宫腔镜检查结果不明确的患者。将子宫内膜活检组织学结果作为主要观察指标。
188例患者未进行活检（17.15%），660例患者病理结果为良性（60.22%），239例患者样本结果不充分（21.81%）。9例患者有癌前病变（0.82%）。癌症发生率为0.00%（n = 0）。宫腔镜检查时子宫内膜视觉萎缩对检测癌前病变或癌症的阴性预测值为99.2%。宫腔镜检查前ET＜4mm且宫腔镜检查时子宫内膜腔萎缩的患者样本不充分的可能性是ET≥4mm患者的2.25倍（p＜0.001，95%可信区间1.61 - 3.16）。10例初次活检样本不充分的患者再次活检样本仍不充分（n = 23，43.48%）。
宫腔镜检查时子宫内膜视觉萎缩的PMB患者中癌前病变/癌症的发生率较低。该队列中的许多患者活检时样本不充分，因此重复取样的价值存疑。
