子宫内膜取样器获取两种标本筛查子宫内膜病变的临床应用研究

Clinical application of two kinds of specimens obtained by endometrial sampler in screening endometrial lesions

目的评价子宫内膜取样器Pipelle获取两种子宫内膜标本筛查子宫内膜病变的临床应用价值。方法采用前瞻性、自身对照的方法,选取2020年12月至2022年3月梧州市工人医院收治的316例存在明确手术指征需进行宫腔镜检查和子宫内膜活检的患者作为研究对象。采用子宫内膜取样器Pipelle获取子宫内膜标本,随后进行宫腔镜检查+常规诊刮术,Pipelle获取的子宫内膜标本同时进行液基细胞学制片及细胞模块石蜡包埋切片,以宫腔镜检查+常规刮宫术的组织学病理作为金标准进行比较。结果(1)常规诊刮术行组织石蜡切片满意率为97.78%(309/316),Pipelle获取标本行液基细胞学制片满意率为93.99%(297/316),行细胞模块石蜡包埋切片满意率为98.40%(311/316),两种石蜡切片的取材满意率均高于液基细胞学制片的取材满意率,差异具有统计学意义(P<0.05);两种石蜡切片的取材满意率比较,差异无统计学意义(P>0.05);Pipelle获取标本时无需麻醉和扩宫,患者无疼痛感。(2)Pipelle获取细胞模块组织病理学与液基细胞学筛查和诊断子宫内膜病变的灵敏度分别为68.75%、40.63%,特异度分别为99.27%、98.10%,阳性预测值分别为91.67%、72.22%,阴性预测值分别为96.45%、93.14%,符合率分别为96.08%、91.86%,Youden指数分别为0.61、0.39,Kappa值分别为0.76、0.47。结论Pipelle获取子宫内膜标本满意率高,标本进行细胞模块包埋石蜡切片组织病理学检查的准确性高于液基细胞学,Pipelle取样操作简便,无需麻醉,无疼痛感,适用于基层医院筛查子宫内膜病变。

Objective To evaluate the clinical application value of Pipelle endometrial sampler in obtaining two kinds of endometrial specimens for screening endometrial lesions.Methods A total of 316 patients with definite surgical indications requiring hysteroscopy and endometrial biopsy admitted to Gongren Hospital of Wuzhou between December 2020 and March 2022 were selected as study objects using a prospective,self⁃controlled method.Endometrial specimens were obtained using the Pipelle endometrial sampler,followed by hysteroscopy and conventional curettage.The endometrial specimens obtained by Pipelle were simultaneously subjected to liquid based cytology and cell module paraffin embedded sections.The histological pathology of hysteroscopy plus conventional curettage was used as the gold standard for comparison.Results(1)The satisfaction rate of tissue paraffin sections obtained by conventional curettage was 97.78%(309/316),while that of liquid based cytology sections obtained by Pipelle was 93.99%(297/316),and the satisfaction rate of paraffin embedded sections of cell modules was 98.40%(311/316).The satisfaction rate of both paraffin sections was higher than that of cytology sections,with a statistically significant difference(P<0.05).There was no significant difference in the satisfaction rate between the two paraffin sections(P>0.05).Pipelle does not require anesthesia and dilation when obtaining specimens,and the patient does not feel pain.(2)The sensitivity for histopathological and liquid based cytological screening and diagnosis of endometrial lesions by Pipelle acquired cell module was 68.75%and 40.63%respectively,with specificity of 99.27%and 98.10%,positive predictive values of 91.67%and 72.22%,negative predictive values of 96.45%and 93.14%,and coincidence rates of 96.08%and 91.86%,respectively.The Youden index was 0.61 and 0.39,and Kappa values were 0.76 and 0.47,respectively.Conclusions Pipelle has a high satisfaction rate in obtaining endometrial specimens,and the accuracy of histopathological examination of specimens using cell module embedded paraffin sections is higher than that of liquid⁃based cytology.Pipelle sampling is simple and convenient to operate,without anesthesia,and without pain.It is suitable for screening endometrial lesions in primary hospitals.