Gubbini G, Filoni M, Linsalata I, Stagnozzi R, Stefanetti M, Marabini A
Istituto di Clinica Ostetrico-Ginecologica, Università degli Studi, Bologna.
Minerva Ginecol. 1998 Apr;50(4):125-33.
Preneoplastic lesions of endometrium such as endometrial hyperplasia (simple and complex with or without cytological atypias) represent an important cause of abnormal uterine bleeding. Among diagnostic techniques, hysteroscopy presents several advantages: it is an out-patient procedure, minimally invasive, repeatable, of rapid execution and with low cost. The hysteroscopic pattern of endometrial hyperplasia appears with an over-development of the endometrial mucosa with increased glandular openings, increased vascularization, cystic dilatations, polypoid aspects.
Since October 1984 to January 1995 at the Gynecologic Endoscopic Service of Obstetrics and Gynecology Department of the University of Bologna, 13,438 hysteroscopies were performed: 291 (2.16%) in patients submitted to hysteroscopy for previous diagnosis of endometrial hyperplasia. The first diagnosis of endometrial hyperplasia was made in 125 (42.3%) patients through hysteroscopic biopsy, while for 166 patients (57.04%) the first diagnosis was made by endometrial curettage of VABRA.
The results showed that the endometrial hyperplasia is typical in perimenopausal age and this finding is more frequently symptomatic. The histological diagnosis after hysteroscopy was: simple hyperplasia in 106 patients (84.8%), complex in 12 patients (9.6%) and atypical in 6 patients (4.8%). One case of simplex hyperplasia was associated with endometrial cancer (0.8%). The comparison between histological diagnosis and hysteroscopic diagnosis showed that agreement is reached in 113 cases (90.4%). However, it is to note that diagnostic agreement of complex hyperplasia cases was about 100%, but in 22 cases the hysteroscopic diagnosis was simplex hyperplasia rather than complex or atypical. The errors of hysteroscopy were observed in 10 cases (8%).
The hysteroscopic diagnosis should not replace histological diagnosis, mostly in hysteroscopies performed after progestagen therapy, because the changes induced by drugs make more difficult the interpretation of hysteroscopy. However, hysteroscopy is complementary to histological analysis since permits a global evaluation of endometrial mucosa, directs biopsy on dishomogeneous areas and represents the only means to make diagnosis when biopsy is not practicable.
子宫内膜的癌前病变，如子宫内膜增生（单纯性和复杂性，伴有或不伴有细胞学异型性）是异常子宫出血的重要原因。在诊断技术中，宫腔镜检查具有多个优点：它是一种门诊手术，微创、可重复、执行迅速且成本低。子宫内膜增生的宫腔镜表现为子宫内膜黏膜过度发育，腺开口增加、血管增生、囊性扩张、息肉样外观。
1984年10月至1995年1月，在博洛尼亚大学妇产科的妇科内镜服务中心进行了13438例宫腔镜检查：其中291例（2.16%）是因先前诊断为子宫内膜增生而接受宫腔镜检查的患者。125例（42.3%）患者通过宫腔镜活检首次诊断为子宫内膜增生，而166例（57.04%）患者的首次诊断是通过VABRA子宫内膜刮除术做出的。
结果显示，子宫内膜增生在围绝经期较为典型，且这一发现更常伴有症状。宫腔镜检查后的组织学诊断为：单纯性增生106例（84.8%），复杂性增生12例（9.6%），非典型增生6例（4.8%）。1例单纯性增生与子宫内膜癌相关（0.8%）。组织学诊断与宫腔镜诊断的比较显示，113例（90.4%）达成了一致。然而，需要注意的是，复杂性增生病例的诊断一致性约为100%，但有22例宫腔镜诊断为单纯性增生而非复杂性或非典型性增生。宫腔镜检查出现错误的有10例（8%）。
宫腔镜诊断不应取代组织学诊断，尤其是在孕激素治疗后进行的宫腔镜检查中，因为药物引起的变化使宫腔镜检查结果的解读更加困难。然而，宫腔镜检查是组织学分析的补充，因为它可以对子宫内膜黏膜进行全面评估，指导在不均匀区域进行活检，并且是在无法进行活检时进行诊断的唯一方法。
