Vasileva Radostina, Meherzi Meriem, Bucau Margot, Courcier Helene, Gonthier Clementine, Koskas Martin
Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France; Faculty of Medicine, Paris Cité University, 15 Rue de l'École de Médecine, 75006 Paris, France.
Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France; Faculty of Medicine, Paris Cité University, 15 Rue de l'École de Médecine, 75006 Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2025 Aug;312:114108. doi: 10.1016/j.ejogrb.2025.114108. Epub 2025 Jun 4.
Hysteroscopy is commonly used for diagnosing benign endometrial conditions, but its diagnostic performance in malignancies post-treatment surveillance has not been evaluated. This study evaluated the correlation between hysteroscopic appearance and histological outcomes in patients in remission after conservative treatment for atypical hyperplasia (AH) or early-stage endometrial cancer (EC).
Multicenter retrospective cohort study utilizing data from the French national register of fertility-sparing management for AH/EC (PREFERE database) from May 2015 to December 2020. The study included patients over 18 years with a prior diagnosis of AH or stage IA1 EC, who achieved remission following progestin-based fertility-sparing treatment. Hysteroscopy and endometrial biopsy were performed for post-remission surveillance. Hysteroscopic appearances were categorized, and the corresponding histopathological results were reviewed as the gold standard for detecting recurrence or remission. Non-suspicious findings (normal or atrophic) and suspicious findings (thickened, polypoid, polyp-like or atypical vessels presence) in hysteroscopy were evaluated for concordance with biopsy results.
The study followed 47 patients in remission yielding in 121 hysteroscopy-biopsy pairings, of which 63 were non-suspicious. Diagnostic accuracy of hysteroscopy was 63 % (95 % CI: 54-71 %), with sensitivity of 71 % (95 % CI: 52-86 %) and specificity of 60 % (95 % CI: 49-70 %). The positive predictive value was 38 %, and the negative predictive value was 86 %. Non-suspicious hysteroscopic findings correlated better with normal histopathology, while suspicious findings were less predictive of recurrence.
The findings highlight the necessity of combining hysteroscopic findings with biopsy for reliable post-treatment monitoring in fertility-sparing management of AH/EC. Hysteroscopy alone lacks sufficient accuracy which aligns with current guidelines and underscores the importance of follow-up protocols to detect recurrence in this high-risk population. Integrating advanced imaging modalities or diagnostic tools based on artificial intelligence may enhance the accuracy of recurrence detection in this patient population.
宫腔镜检查常用于诊断良性子宫内膜疾病，但其在恶性肿瘤治疗后监测中的诊断性能尚未得到评估。本研究评估了非典型增生（AH）或早期子宫内膜癌（EC）保守治疗后缓解期患者宫腔镜表现与组织学结果之间的相关性。
多中心回顾性队列研究，利用2015年5月至2020年12月法国AH/EC保留生育功能管理国家登记处（PREFERE数据库）的数据。该研究纳入了年龄超过18岁、先前诊断为AH或IA1期EC且在基于孕激素的保留生育功能治疗后达到缓解的患者。缓解期后进行宫腔镜检查和子宫内膜活检。对宫腔镜表现进行分类，并将相应的组织病理学结果作为检测复发或缓解的金标准进行回顾。评估宫腔镜检查中无可疑发现（正常或萎缩）和可疑发现（增厚、息肉样、息肉状或存在非典型血管）与活检结果的一致性。
该研究对47例缓解期患者进行了随访，共获得121对宫腔镜-活检结果，其中63例无可疑发现。宫腔镜检查的诊断准确性为63%（95%CI：54-71%），敏感性为71%（95%CI：52-86%），特异性为60%（95%CI：49-70%）。阳性预测值为38%，阴性预测值为86%。无可疑的宫腔镜检查结果与正常组织病理学的相关性更好，而可疑发现对复发的预测性较低。
研究结果强调了在AH/EC保留生育功能管理中，将宫腔镜检查结果与活检相结合以进行可靠的治疗后监测的必要性。单独的宫腔镜检查缺乏足够的准确性，这与当前指南一致，并强调了随访方案在该高危人群中检测复发的重要性。整合基于人工智能的先进成像模式或诊断工具可能会提高该患者群体中复发检测的准确性。
