不孕患者子宫内膜阴道超声、宫腔镜与病理符合率的探讨

The coincidence rate of endometrial transvaginal ultrasound, hysteroscopy and pathology in infertile patients

目的 探讨不孕患者子宫内膜宫腔镜、阴道超声与病理符合率。方法 回顾性选取2018年1月至2021年6月在本院生殖中心门诊行宫腔镜检查的不孕患者,共407例,对比子宫内膜阴道超声、宫腔镜与病理符合率。结果 阴道超声诊断内膜异常的敏感度为41.96%,特异度为77.97%,假阳性率(误诊率)22.03%,假阴性率(漏诊率)58.04%,阳性预测值41.96%,阴性预测值77.92%,约登指数0.20。宫腔镜诊断内膜异常的敏感度为88.39%,特异度为72.2%,假阳性率(误诊率)27.12%,假阴性率(漏诊率)11.61%,阳性预测值54.70%,阴性预测值94.25%,约登指数0.61。宫腔镜检查子宫内膜异常阳性率较阴道超声检查的阳性率高,比较差异具有统计学意义(P<0.05)。结论 阴道超声对于不孕患者子宫内膜病变的诊断简单、无创,可做为初步筛查,而宫腔镜可更加准确和全面的评估内膜病变,但都存在局限性,需要继续探索更全面、系统地方法以发现不孕患者子宫内膜病变。

Objective To investigate the coincidence rate of endometrial hysteroscopy, transvaginal ultrasound and pathology in infertile patients. Methods A total of 407 infertile patients who underwent hysteroscopy in the outpatient department of the reproductive center of our hospital from January 2018 to June 2021 were retrospectively selected, and the coincidence rates of endometrial vaginal ultrasonography, hysteroscopy and pathology were compared. Results The sensitivity of transvaginal ultrasonography in the diagnosis of endometrial abnormalities was 41.96%, the specificity was 77.97%, the false positive rate(misdiagnosis rate) was 22.03%, the false negative rate(missing diagnosis rate) was 58.04%, the positive predictive value was 41.96%, and the negative predictive value was 77.92. %, the Youden index was 0.20. The sensitivity of hysteroscopy in the diagnosis of endometrial abnormalities was 88.39%, the specificity was 72.2%, the false positive rate(misdiagnosis rate) was 27.12%, the false negative rate(missing diagnosis rate) was 11.61%, the positive predictive value was 54.70%, and the negative predictive value was 94.25. %, the Youden index was 0.61. The positive rate of abnormal endometrium in hysteroscopy was higher than that in vaginal ultrasonography, and the difference was statistically significant(P<0.05). Conclusion transvaginal ultrasound for the diagnosis of endometrial lesions in infertile patients is simple, non-invasive, can be used as a preliminary screening, and hysteroscopy can be more accurate and comprehensive evaluation of endometrial lesions, but there are limitations, need to continue to explore more comprehensive and systematic methods to find endometrial lesions in infertile patients.