阴道超声、宫腔镜及内膜活检诊断子宫内膜癌的临床观察

Clinical Observation of Transvaginal Hysteroscopy with Endometrial Biopsy in Ultrasound and Diagnosis of Endometrial Carcinoma

目的:对经阴道超声(TVS)、宫腔镜和诊断性刮宫并内膜活检在绝经后阴道出血首诊患者诊断子宫内膜癌的作用进行比较,对以何种方法进行子宫内膜癌筛查进行评估。方法:回顾性分析我院2007年6月-2011年6月收治的216例以绝经后阴道出血为首诊症状的患者的临床资料,分别行TVS、宫腔镜和诊断性刮宫取内膜活检等检查,分别计算其诊断子宫内膜癌的灵敏度、特异度、阳性预测值、阴性预测值及ROC曲线下面积,比较三者的临床价值。结果:以子宫内膜≥5mm为临界值,TVS诊断内膜癌的灵敏度和特异度分别为95.8%和7.4%,阳性预测值10.6%,阴性预测值93.3%(ROC曲线下面积:0.812)。以子宫切除后病理诊断为金标准,宫腔镜的灵敏度和特异度分别为100%和98.1%,阳性预测值90%,阴性预测值100%(ROC曲线下面积:0.968);内膜活检的灵敏度和特异度分别为96.8%和100%,阳性预测值100%,阴性预测值99.0%(ROC曲线下面积:0.999)。结论:TVS以5mm为临界值对绝经后阴道出血患者诊断内膜癌的灵敏度较高,但对于子宫内膜厚度<5mm者,可能会造成漏诊。对于绝经后阴道出血的患者均应常规行宫腔镜检查和内膜诊刮以提高内膜癌诊断率。

Objective：To compare accuracy of transvaginal ultrasound（TVS） in measuring endometrial thickness and accuracy of hysteroscopy and endometrial curettage in diagnosing endometrial carcinoma in an attempt to find an optimal way of detecting endometrial carcinoma early in postmenopausal women who had abnormal vaginal bleeding.Methods：This retrospective study was conducted 216 consecutive postmenopausal patients with abnormal uterine bleeding,who underwent transvaginal ultrasound evaluation of endometrial thickness,hysteroscopy and endometrial curettage.Sensitivity,specificity,positive and negative predictive values were performed and a receiver operator characteristic curve（ROC） was calculated.Results：Given endometrial thickness ≥5mm as the critical value,the sensibility and specificity of TVS was 95.8% and 7.4% respectively,and the positive predictive value was 10.6% and the negative predictive value was 93.3%（ROC curve：0.812）.Hysteroscopy revealed sensitivity 100%,specificity 98.1%,positive predictive value 90.0% and negative predictive value 100% according to histologic findings of surgical specimens underwent hysterectomy（ROC curve：0.968）.As well,endometrial biopsy revealed sensitivity were 96.8%,specificity 100%,positive predictive value 100% and negative predictive value 99%（ROC curve：0.999）.Conclusions：Trans-vaginal ultrasound is the first line diagnostic procedure in postmenopausal women with abnormal uterine bleeding.Though there is a high sensibility with a cut-off value ≥5mm,but endometrial thickness 5mm can miss malignancies.Hysteroscopy with endometrial curettage is mandatory in all postmenopausal women with abnormal uterine bleeding.