A New Hysteroscopic Risk Scoring System for Diagnosing Endometrial Hyperplasia and Adenocarcinoma

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• 作者：Manuel Maria Ianieri ; MD^a ; ^{manuel_dorian@yahoo.it" class="auth_mail" title="E-mail the corresponding author} ; Tommaso Staniscia ; MD^b ; Giovanni Pontrelli ; MD^a ; Attilio Di Spiezio Sardo ; MD ; PhD^c ; Federica Stella Manzi ; MD^d ; Maristella Recchi ; MD^e ; Marco Liberati ; MD ; PhD^f ; ^g ; Marcello Ceccaroni ; MD ; PhD^a
• 关键词：Endometrial cancer ; Endometrial hyperplasia ; Hysterscopy
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：July-August 2016
• 年：2016
• 卷：23
• 期：5
• 页码：712-718
• 全文大小：342 K

文摘

To develop a new hysteroscopic morphologic scoring system that helps physicians, especially those who have less experience, to make a differential diagnosis among normal endometrium (NE), endometrial hyperplasia, and endometrial carcinoma.

Design

A retrospective study (Canadian Task Force Classification II).

Setting

An office hysteroscopy service.

Patients

A total of 435 endometrial biopsies were included in the study: 201 NE, 160 endometrial hyperplasia without atypia (EH), 30 atypical endometrial hyperplasia (AEH), and 44 endometrial cancer (EC).

Interventions

The authors retrospectively evaluated all videos of diagnostic hysteroscopies performed before endometrial biopsies to note endometrial morphologic parameters suggestive of pathology. Principal significant variables were selected by means of the chi-square test (p < .05) and integrated into an ordinal multivariate analysis. Through the estimate of the beta coefficient, a score was obtained to be appointed to each of the selected variables, and characteristic intervals of each of the endometrial lesions were created.

Measurements and Main Results

The scoring system showed a sensitivity and specificity of 71.1% and 80%, 48.7% and 82.5%, 63.3% and 90.4%, and 95.4% and 98.2% regarding NE, EH, AEH, and EC, respectively. The positive predictive values and negative predictive values, respectively, were 76.8% and 80% for NE, 62% and 73.5% for EH, 32.7% and 97% for AEH, and 85.7% and 99.5% for EC.

Conclusions

The proposed scoring system showed good diagnostic performance, especially in relation to endometrial cancer, and may represent a useful diagnostic tool, mainly for operators with less experience.