窄带成像宫腔镜在子宫内膜病变诊断中的应用研究

Application of narrow-band imaging hysteroscopy in the diagnosis of endometrial lesions

目的探讨窄带成像(narrow-band imaging,NBI)宫腔镜和普通白光成像(white light imaging,WLI)宫腔镜在子宫内膜病变诊断中的应用价值。方法选取行宫腔镜诊断者213例,行宫腔镜检查,对发现的病灶依次使用WLI和NBI模式进行病灶性质的判断,以病理诊断作为金标准,比较两种观察模式对子宫内膜病变的诊断作用。结果213例患者中共取病灶标本442份,病理诊断:正常56份(占12.7%)、子宫内膜息肉62份(占14.0%)、黏膜下肌瘤15份(占3.4%)、子宫内膜炎28份(占6.3%)、萎缩性子宫内膜34份(占7.7%)、子宫内膜蜕膜样变33份(占7.5%)、低风险子宫内膜增生49份(占11.1%,包括单纯性增生31份、复杂性增生18份)、高风险内膜增生(子宫内膜轻、中、重度非典型增生)92份(占20.8%)、子宫内膜癌53份(占12.0%)。①对于单纯性增生和复杂性增生:NBI和WLI诊断的灵敏度分别为79.6%和49.0%(P=0.003);特异度分别为99.0%和97.2%,(P=0.039)。②对于子宫内膜非典型增生:NBI和WLI诊断的灵敏度分别为93.5%和82.6%(P=0.006);特异度分别为99.1%和92.3%(P=0.001)。③对于子宫内膜癌:NBI和WLI诊断的灵敏度分别为98.1%和73.6%(P=0.000);特异度为99.0%和97.4%(P=0.031),差异均有统计学意义。结论 NBI宫腔镜可以提高对子宫内膜病变诊断的灵敏度和特异度。子宫内膜血管形态和结构的改变越明显,NBI宫腔镜诊断的灵敏度越高;对异型血管的判断,有助于镜下区分子宫内膜良性增生、子宫内膜不典型增生和子宫内膜癌。NBI宫腔镜可加强宫腔镜下内膜定位活检的针对性,减少漏诊。

Objective To investigate the value of narrowband imaging （NBI） technology for improving the diag nostic reliability of hysteroscopy by studying the application of NBI and white light imaging （WLI） hysteroscopy in the di agnosis of endometrial lesions. Methods From March 2011 to November 2013, a total of 213 patients with suspected en dometrial lesions who were examined with hysteroscopy equipped with the white light mode and NBI mode. Using the pathological diagnosis as the goldstandard, we evaluated the value of NBI hysteroscopy in detecting positive lesions which included endometrial carcinoma and atypical endometrial hyperplasia. Results Among the 213 patients, a total of 442 lesions were detected by WLI and NBI hysteroscopy. The pathological diagnoses of these lesions were as follows：56 were normal endometrium （13% of total）, 33 were endometrial decidual changes due to MPA （8% of total）, 49 were low risk endometrial hyperplasia （12% of total, including 31 simple hyperplasia and 18 complicacy hyperplasia）, 92 were high risk endometrial hyperplasia （atypical endometrial hyperplasia, 21% of total）, 53 were endometrial carcinoma （13% of to tal）. For simple hyperplasia and complicacy byperplasia, the sensitivity of NBI and WLI was 79.6% （39/49）and 49.0% （24/ 49）（ P = 0.003）; the specificity of NBI and WLI was 99.0%（389/393）and 97.2%（382/393）, P = 0.039. For atypical endo metrial hyperplasia, the sensitivity of NBI and WLI was 93.5% （86/92）and 82.6% （76/92）, P = 0.006; the specificity of NBI and WLI was 99.1% （347/350） and 92.3% （332/350）, P = 0.001. For endometrial carcinoma, the sensitivity of NBI and WLI was 98.1% （52/53）and 73.6% （39/53）, P = 0.000; the specificity of NBI and WLI was 99.0% （385/389）and 97.4% （379/389）, P = 0.031, in which the difference was significant. Conclusion Compared with WLI hysteroscopy, NBI hysteroscopy can improve the sensitivity and specificity of the diagnosis of endometrial lesions. Hysteroscopic diagnosis has better concordance with pathological diagnosis in the NBI mode. NBI hysteroscopy is easy to be applied in uter ine cavity examination and endometrial biopsy has high sensitivity and specificity in detecting the morphology of mucosal capillary vessels. This approach can not only improve the relevance and accuracy of the biopsy, but also reduce the missed diagnosis of endometrial lesions.The more obviously endometrial vascular changes, the higher sensitivity of the NBI hys teroscopy has. NBI hysteroscopy has advantage in the judgment of the atypical blood vessels. It help to distinguish endo metritis, benign endometrial hyperplasia, atypical endometrial hyperplasia and endometrial carcinoma.