改良子宫内膜采集器在阴道内镜下的临床应用
|
摘要
目的评价改良子宫内膜采集器联合阴道内镜检查诊断子宫内膜病变的临床应用价值。方法2015年5月至2015年10月对74例可疑宫腔病变患者应用改良子宫内膜采集器(改良采集器组)通过阴道内镜检查评估宫腔状态后采集子宫内膜组织送病理学检查,并与宫腔镜检查定位诊断性刮宫(诊刮组)结果进行比较。结果子宫内膜采集器及宫腔镜定位诊断性刮宫标本满意率均为94.59%(70/74)。74例患者中,改良采集器组确诊为子宫内膜恶性病变7例,其特异度为98.41%(62/63),灵敏度为63.64%(7/11),诊刮组确诊为子宫内膜恶性病变11例,两种方法的符合率为93.24%(69/74),Kappa值为0.699,ROC曲线下面积为0.810。结论使用改良子宫内膜采集器可在阴道内镜检查后直接进行内膜活检,并且可获取较满意标本。
Objective To evaluate the clinical value of the modified endometrial sampler combined with vaginoscopic hysteroscopy in terms of diagnosis of endometrial lesions.Methods From May 2015 to October 2015,endometrium tissues were collected with modified endometrial sampler at vaginoscopic hysteroscopy(modified endometrial sampler group) and hysteroscopy and curettage(curettage group) from 74 patients with suspicious uterine cavity lesions.The pathologic diagnosis of samples obtained by different methods was compared.Results Biopsy was adequate in 94.59%(70/74) for both endometrial sampler and hysteroscopy and curettage.Eleven patients were diagnosed with endometrial malignant lesions by hysteroscopy and curettage,while seven patients were diagnosed with endometrial sampling device.The specificity and sensitivity of pathology was 98.41%(62/63) and 63.64%(7/11),the total consistent rate was 93.24%(69/74),and finally the Kappa estimated value was 0.688,area under ROC curve was 0.810.Conclusion The modified endometrial sampler makes it possible to perform endometrial biopsy with vaginoscopic hysteroscopy,and can obtain adequate endometrial tissue for histological diagnosis.
Objective To evaluate the clinical value of the modified endometrial sampler combined with vaginoscopic hysteroscopy in terms of diagnosis of endometrial lesions.Methods From May 2015 to October 2015,endometrium tissues were collected with modified endometrial sampler at vaginoscopic hysteroscopy(modified endometrial sampler group) and hysteroscopy and curettage(curettage group) from 74 patients with suspicious uterine cavity lesions.The pathologic diagnosis of samples obtained by different methods was compared.Results Biopsy was adequate in 94.59%(70/74) for both endometrial sampler and hysteroscopy and curettage.Eleven patients were diagnosed with endometrial malignant lesions by hysteroscopy and curettage,while seven patients were diagnosed with endometrial sampling device.The specificity and sensitivity of pathology was 98.41%(62/63) and 63.64%(7/11),the total consistent rate was 93.24%(69/74),and finally the Kappa estimated value was 0.688,area under ROC curve was 0.810.Conclusion The modified endometrial sampler makes it possible to perform endometrial biopsy with vaginoscopic hysteroscopy,and can obtain adequate endometrial tissue for histological diagnosis.
引文
[1]Cooper NA,Smith P,Khan KS,et a1.Vaginoscopic approach to outpatient hysteroscopy:a systematic review of the effect on pain.BJOG,2010,117:532-539.
[2]Cooper NA,Robinson LL,Clark TJ.Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding.J Fam lann Reprod Health Care,2015,41:284-291.
[3]陈乐真,陈晓瑞,沈丹华.妇产科诊断病理学.2版.北京:人民军医出版社,2014:196-216.
[4]Di Spiezio Sardo A,Sharma M,Taylor A,et a1.A new device for“no touch”biopsy at“no touch”hysteroscopy:the H Pipelle.Am J Obstet Gynecol,2004,191:157-158.
[5]Dacco'MD,Moustafa M,Papoutsis D,et a1.An audit of using the H Pipelle for endometrial sampling utpatient hysteroscopy and literature review comp arison with the Pipelle de Cornier.Eur J Obstet Gynecol Reprod Biol,2012,165:299-301.
[6]刘从容,林杰.子宫内膜取样器与子宫内膜分段诊刮结果的对照研究.中国妇产科临床杂志,2009,10:353-355.
[7]Sanam M,Majid MM.Comparison the diagnostic value of dilatation and curettage versus endometrial biopsy by Pipelle-a clinical trial.Asian Pac J Cancer Prev,2015,16:4971-4975.
[8]周蓉,沈丹华,唐志坚,等.子宫内膜采集器在子宫内膜癌及癌前病变筛查中的应用.中国妇产科临床杂志,2013,14:150-152.
[2]Cooper NA,Robinson LL,Clark TJ.Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding.J Fam lann Reprod Health Care,2015,41:284-291.
[3]陈乐真,陈晓瑞,沈丹华.妇产科诊断病理学.2版.北京:人民军医出版社,2014:196-216.
[4]Di Spiezio Sardo A,Sharma M,Taylor A,et a1.A new device for“no touch”biopsy at“no touch”hysteroscopy:the H Pipelle.Am J Obstet Gynecol,2004,191:157-158.
[5]Dacco'MD,Moustafa M,Papoutsis D,et a1.An audit of using the H Pipelle for endometrial sampling utpatient hysteroscopy and literature review comp arison with the Pipelle de Cornier.Eur J Obstet Gynecol Reprod Biol,2012,165:299-301.
[6]刘从容,林杰.子宫内膜取样器与子宫内膜分段诊刮结果的对照研究.中国妇产科临床杂志,2009,10:353-355.
[7]Sanam M,Majid MM.Comparison the diagnostic value of dilatation and curettage versus endometrial biopsy by Pipelle-a clinical trial.Asian Pac J Cancer Prev,2015,16:4971-4975.
[8]周蓉,沈丹华,唐志坚,等.子宫内膜采集器在子宫内膜癌及癌前病变筛查中的应用.中国妇产科临床杂志,2013,14:150-152.