分析宫腔镜检查在子宫内膜癌及癌前病变的临床价值

Analysis of the clinical value of hysteroscopy in endometrial carcinoma and precancerous lesions

目的:探究宫腔镜检查诊断子宫内膜癌及癌前病变的临床价值。方法:选取2016年7月-2019年7月因异常子宫出血或绝经后出血且B超提示宫内异常回声或子宫内膜增厚患者100例,均行宫腔镜检查及定位活检或分段性诊刮。以病理诊断为标准,比较宫腔镜诊断与病理诊断的异常检出率;比较宫腔镜诊断子宫内膜良性病变与子宫内膜癌及癌前病变的准确率;计算宫腔镜检查子宫内膜癌及癌前病变的敏感性、特异性及阳性预测值及阴性预测值。结果:宫腔镜诊断与病理诊断的异常检出率比较,差异无统计学意义(P>0.05);宫腔镜诊断子宫内膜癌及癌前病变与子宫内膜良性病变的准确率比较,差异无统计学意义(P>0.05)。宫腔镜检查子宫内膜癌的敏感性为92.31%,特异性为97.70%,阳性预测值为85.71%,阴性预测值为98.84%;子宫内膜不典型增生的敏感性为80.00%,特异性为97.65%,阳性预测值为85.71%,阴性预测值为96.51%。结论:宫腔镜检查诊断子宫内膜癌及癌前病变的准确率较高,联合病理检查可减少漏诊,临床价值显著。

Objective:To explore the clinical effect of hysteroscopy in the diagnosis of endometrial cancer and precancerous lesions.Methods:From July 2016 to July 2019,100 cases of patients with abnormal uterine bleeding or postmenopausal bleeding and their B ultrasound indicated abnormal echo or thickening of endometrium were enrolled,all of them performed hysteroscopy and local biopsy or segmental diagnosis and curettage.On the basis of pathological diagnosis,the abnormal detection rate of hysteroscopy and pathological diagnosis were compared.The accuracy of hysteroscopy in diagnosis of benign endometrial lesions and endometrial carcinoma and precancerous lesions were compared.The sensitivity,specificity,positive predictive value and negative predictive value of hysteroscopy for endometrial carcinoma and precancerous lesions were calculated.Results:The abnormal detection rate of hysteroscopic diagnosis and pathological diagnosis was compared,the difference was not statistically significant(P>0.05).The diagnostic accuracy of hysteroscopy in endometrial carcinoma and precancerous lesions with benign endometrial lesions was compared,the difference was not statistically significant(P>0.05).The sensitivity of hysteroscopy for endometrial cancer was 92.31%,the specificity was 97.70%,the positive predictive value was 85.71%and the negative predictive value was 98.84%.The sensitivity of atypical hyperplasia of endometrium was 80.00%,specificity was 97.65%,positive predictive value was 85.71%,negative predictive value was 96.51%.Conclusion:Hysteroscopy is more accurate in diagnosing endometrial cancer and precancerous lesions,combined with pathological examination can reduce missed diagnosis and the clinical value is significant.