宫腔镜与经阴道超声对子宫内膜病变诊断特异性、敏感度比较分析

Comparative analysis of diagnostic specificity and sensitivity of hysteroscopy and transvaginal ultrasound in diagnosis of endometrial lesions

目的探讨经阴道超声、宫腔镜检查诊断子宫内膜病变的临床价值。方法选取2015年1月至2016年1月首都医科大学附属北京妇产医院妇科门诊高度怀疑为子宫内膜病变的237例患者作为研究对象,所有纳入患者均经过经阴道超声、宫腔镜检查,以活检或术后病理检查结果作为临床诊断金标准,对比这两种检查方法诊断子宫内膜病变的临床价值。结果宫腔镜检查诊断子宫内膜息肉、慢性非特异性内膜炎、正常子宫内膜的准确率显著高于经阴道超声检查,差异具有统计学意义(χ~2值分别为4.303、10.629、11.497,均P<0.05);宫腔镜检查诊断子宫内膜增生、黏膜下肌瘤、子宫内膜萎缩、早期子宫内膜癌的准确率与经阴道超声比较差异无统计学意义(χ~2值分别为2.349、2.744、2.111、1.400,均P>0.05);经阴道超声诊断子宫内膜病变的灵敏度为67.82%、特异度为51.42%、漏诊率为32.18%、误诊率为48.57%、ROC曲线下面积AUC值为0.661;宫腔镜检查诊断子宫内膜病变的灵敏度为86.14%、特异度为88.57%、漏诊率为13.86%、误诊率为11.43%、ROC曲线下面积AUC值为0.867。结论宫腔镜检查诊断子宫内膜病变的灵敏度、特异度均优于经阴道超声,但是经阴道超声具有简便、操作简单的优点。

Objective To discuss the clinical value of transvaginal ultrasound and hysteroscopy（HS） in diagnosis of endometrial lesions.Methods Totally 237 cases highly suspected with endometrial lesions were selected during January 2015 to January 2016 in Beijing Obstetrics and Gynecology Hospital of Capital Medical University.All patients accepted transvaginal ultrasound and HS examination.The results of biopsy or postoperative pathological results were accepted as gold standard for clinical diagnosis.The clinical value of two kinds of examination in the diagnosis of endometrial lesions was compared.Results The accuracy rate of HS in diagnosis of endometrial polyps,chronic nonspecific endometritis and normal endometrium was significantly higher than that of transvaginal ultrasound,and the differences were statistically significant（χ~2value was 4.303,10.629 and 11.497,respectively,all P〈0.05）.There was no significant difference in the accuracy rate in diagnosis of endometrial hyperplasia,submucosal myoma,endometrial atrophy and early endometrial carcinoma between HS and transvaginal ultrasound（χ~2value was 2.349,2.744,2.111 and 1.400,respectively,all P〉0.05）.The sensitivity of transvaginal ultrasound in diagnosis of endometrial lesions was 67.82%,the specificity was 51.42%,the rate of missed diagnosis was32.18%,the misdiagnosis rate was 48.57%,and the AUC value of area under ROC curve was 0.661.The sensitivity of HS examination in diagnosis of endometrial lesions was 86.14%,the specificity was 88.57%,the rate of missed diagnosis was 13.86%,the misdiagnosis rate was 11.43%,and the AUC value of area under ROC curve was 0.867.Conclusion The sensitivity and specificity of HS in diagnosis of endometrial lesions are better than those of transvaginal ultrasound,but transvaginal ultrasound is simple and easy to operate.