Khalife Tarek, Afsar Selim, Brien Amy L, Carrubba Aakriti R, Griffith Megan P, Casper Katie, Butler Kristina A, Rassier Sarah L Cohen
Obstetrics and Gynecology Department, Mayo Clinic Health System (Drs. Khalife and Casper), Mankato, Minnesota.
Department of Gynecologic Oncology, Balikesir University (Dr. Afsar), Istanbul, Turkey.
J Minim Invasive Gynecol. 2025 Aug;32(8):725-730. doi: 10.1016/j.jmig.2025.03.021. Epub 2025 Mar 29.
To compare the diagnostic performance of hysteroscopy-guided versus blind sampling in detecting concurrent endometrial carcinoma in patients with endometrial intraepithelial neoplasia (EIN) and to identify factors associated with missing cancer diagnosis.
This is a retrospective cohort study.
Integrated academic and community healthcare system in Minnesota and Wisconsin, USA, January 1, 2018, and January 1, 2023.
This included 151 patients diagnosed with EIN during endometrial sampling who underwent a hysterectomy within 3 months. Patients with concurrent cancer diagnoses were excluded.
Patients diagnosed with EIN using hysteroscopy-directed biopsy were compared to those diagnosed with blind-sampling methods using the pathology results of the subsequent hysterectomy specimen as the gold standard comparator to analyze rates of missed endometrial cancer (EC) diagnosis.
The primary outcome was a reduced risk of unanticipated concurrent EC on the final hysterectomy pathology result for patients diagnosed with endometrial intraepithelial hyperplasia via a hysteroscopy-directed biopsy (odds ratios [OR] = 0.44, 95% confidence intervals [CI] = 0.20-0.95, p = .033). In multivariate analysis, body mass index ≥30 and patient age >60 were associated with an elevated risk of EC on final pathology (OR = 4.17, 95% CI = 1.51-11.51, p = .004; OR = 5.56, 95% CI = 1.22-35.21, p < .001), respectively, and diabetes mellitus was the only independent variable associated with a higher risk of EIN on final hysterectomy pathology (OR = 7.01, 95% CI = 1.40-35.04, p = .018). Age, body mass index, and endometrial thickness on pre-biopsy ultrasound were not associated with an increased risk of overlooking concurrent endometrial carcinoma on final hysterectomy pathology on univariate and multivariate analyses.
Hysteroscopy-directed biopsy may reduce the risk of missing a concurrent endometrial malignancy during endometrial sampling in women with EIN. The results affirm the superior diagnostic accuracy of hysteroscopy-directed endometrial evaluation.
比较宫腔镜引导下采样与盲目采样在检测子宫内膜上皮内瘤变（EIN）患者并发子宫内膜癌方面的诊断性能，并确定与漏诊癌症相关的因素。
这是一项回顾性队列研究。
美国明尼苏达州和威斯康星州的综合学术与社区医疗系统，2018年1月1日至2023年1月1日。
这包括151例在子宫内膜采样期间被诊断为EIN且在3个月内接受子宫切除术的患者。排除并发癌症诊断的患者。
将使用宫腔镜引导活检诊断为EIN的患者与使用盲目采样方法诊断的患者进行比较，以随后子宫切除标本的病理结果作为金标准对照，分析子宫内膜癌（EC）漏诊率。
主要结局是，对于通过宫腔镜引导活检诊断为子宫内膜上皮内增生的患者，最终子宫切除病理结果中意外并发EC的风险降低（优势比[OR]=0.44，95%置信区间[CI]=0.20-0.95，p=0.033）。在多变量分析中，体重指数≥30和患者年龄>60岁与最终病理中EC风险升高相关（OR分别为4.17，95%CI=1.51-11.51，p=0.004；OR为5.56，95%CI=1.22-35.21，p<0.001），糖尿病是最终子宫切除病理中与EIN风险较高相关的唯一独立变量（OR=7.01，95%CI=1.40-35.04，p=0.018）。在单变量和多变量分析中，活检前超声检查时的年龄、体重指数和子宫内膜厚度与最终子宫切除病理中漏诊并发子宫内膜癌的风险增加无关。
宫腔镜引导下活检可能会降低EIN女性在子宫内膜采样期间漏诊并发子宫内膜恶性肿瘤的风险。结果证实了宫腔镜引导下子宫内膜评估具有更高的诊断准确性。
