窄带成像宫腔镜在诊断子宫内膜癌及内膜非典型增生中的价值

Narrow-band Imaging Hysteroscopy for the Diagnosis of Endometrial Cancer and Endometrial Atypical Hyperplasia

目的探讨窄带成像(narrow band imaging,NBI)宫腔镜在子宫内膜癌及内膜非典型增生诊断中的应用价值。方法 2009年6月～2011年6月,对189例异常子宫出血可疑子宫内膜病变患者行电子宫腔镜检查,对宫腔内膜依次使用白光和NBI模式进行分类和病灶性质的判断,以病理诊断作为金标准,比较两种观察模式对子宫内膜癌及内膜非典型增生诊断的作用。结果 189例共取子宫内膜病理标本334份,其中病理阳性病灶(包括子宫内膜癌及子宫内膜非典型增生)127份,阴性病灶(正常子宫内膜及内膜良性病变)207份。依照子宫内膜癌及子宫内膜非典型增生的宫腔镜下诊断特征:病灶增厚高出周边内膜、异型血管和(或)组织坏死致病灶表面毛糙不规则,NBI及白光宫腔镜对子宫内膜癌及内膜非典型增生诊断的准确率为93.7%(313/334)及84.7%(283/334)(χ2=14.010,P=0.000),敏感性为95.3%(121/127)及79.5%(101/127)(χ2=14.302,P=0.000),NBI模式均显著高于白光;二者诊断的特异性为92.8%(192/207)及87.9%(182/207)(χ2=2.767,P=0.096),差异无显著性。结论 NBI弥补了普通光宫腔镜对病变形态学识别的不足,可明显提高对子宫内膜癌及内膜非典型增生诊断的敏感性和准确率,NBI指导下的对宫腔内病变的定位活检具有良好的临床应用前景。

Objective To evaluate the value of narrow band imaging （NBI） hysteroscopy in the diagnosis of endometrial cancer and atypical endometrial hyperplasia. Methods From June 2009 to June 2011, a total of 189 patients with suspected endometfial lesions were examined with hysteroseopy equipped with the white light mode or NBI mode. With pathological diagnosis as a goldern standard, we evaluated the value of NBI hysteroscopy in detecting positive lesions inlcuding endometrial carcinoma and atypical endometrial hyperplasia （ t〉 AEH）. Results Totally 334 samples were obtained, including 127 positive lesions and 207 benign endometrial samples （ 〈 AEH）. Protruding lesions with rough or irregular surface, atypical vessels with or without necrosis were the characteristics of positive lesions shown by hysteroseopy. The accuracy, sensitivity and specificity of NBI and white light hysteroscopy in predicting cancer and hyperplasia were, 93. 7% （313/334） and 84. 7% （283/334） （X2 = 14. 010, P = 0. 000） , 95. 3% （121/127） and 79.5% （101/127） （X2 =14.302, P=0.000）, and 92.8% （192/207） and 87.9% （182/207） （X2 =2.767, P= 0. 096） , respectively. NBI hysteroscopy showed significantly higher accuracy and sensitivity for the detection of endometrial cancer and atypical endometrial hyperplasia. There was no significantly difference in specificity between the two methods. Conclusions NBI hysteroseopy can significantly increase the detection rate of endometrial cancer and atypical endometrial hyperplasia. It is a promising diagnostic method for the lesions.