宫腔镜窄带成像技术诊断不同类型子宫内膜增生性病变的价值  

Clinical value of hysteroscopy with narrow-band imaging in diagnosis of different endometrial lesions

作　　者：谢妍 韩璐 王敏 王晓东 郭玲莉 孙燕茹 Yan Xie;Lu Han;Min Wang;Xiao-dong Wang;Ling-li Guo;Yan-ru Sun(Department of Gynecology, Dalian Obstetrics and Gynecology Hospital affiliated to Dalian Medical University, Dalian, Liaoning 116033, China)

机构地区：[1]大连医科大学附属大连市妇产医院暨大连市妇幼保健院妇科,辽宁大连116033

出　　处：《中国内镜杂志》2017年第12期14-19,共6页China Journal of Endoscopy

基　　金：大连市科技计划项目(No:2014E14SF160)

摘　　要：目的探讨宫腔镜窄带成像技术(NBI)诊断不同类型子宫内膜增生性病变的价值。方法选取148例异常子宫出血患者行宫腔镜检查,分别于白光和NBI模式下观察子宫内膜,对可疑病灶行靶向活检,送病理组织学检查。以病理诊断为金标准,比较白光与NBI模式对不同分类子宫内膜增生性病变的诊断价值。结果低危型子宫内膜增生性病变表现以Ⅱ型微血管为主,高危型子宫内膜增生性病变以Ⅲ~Ⅳ型微血管为主。宫腔镜白光及NBI模式诊断低危型子宫内膜增生性病变的敏感性分别为65.52%及86.21%,差异有统计学意义(χ~2=6.78,P=0.009);NBI模式诊断低危型子宫内膜增生性病变与病理学诊断一致性中等(Kappa值为0.617)。宫腔镜白光、NBI模式诊断高危型子宫内膜增生性病变的准确率分别为81.08%及89.86%(χ~2=4.60,P=0.032),敏感性分别为57.14%及92.86%(χ~2=14.29,P=0.000),阴性预测值分别为84.21%及96.91%(χ~2=9.43,P=0.002),差异均有统计学意义;特异性分别为90.57%及88.68%(χ~2=0.20,P=0.652),阳性预测值分别为70.59%及76.47%(χ~2=0.37,P=0.544),差异均无统计学意义;NBI模式诊断高危型子宫内膜增生性病变与病理学诊断有较好的一致性(Kappa值为0.766)。结论宫腔镜NBI可清晰地观察子宫内膜表面及深层的微血管形态变化,有助于减少低危型子宫内膜增生性病变的漏诊,提高诊断高危型子宫内膜增生性病变的准确率。NBI在诊断不同分类子宫内膜病变中具有一定临床应用价值。Objective To study the clinical value of hysteroscopy with narrow-band imaging(NBI)in diagnosis of different endometrial lesions.Methods148patients suffered from abnormal uterine bleeding with hysteroscopy examination and observed under hysteroscopy with ordinary white light and the NBI model respectively.Suspicious lesions targeted biopsy and gave pathological examination.With pathological diagnosis as a golden standard,it evaluated the value of hysteroscopy with NBI in different type of endometrial lesions.Results Low-risk type of endometrial lesions gave priority to type II microvascular and high-risk type of endometrial lesions gave priority to type III^IV microvascular.Sensitivity of low-risk endometrial lesions under white light and NBI modes was65.52%and86.21%respectively(χ2=6.78,P=0.009),the difference was statistically significant in the two modes.The diagnosis of endometrial lesions low-risk type with NBI mode had medium consistency compared with the pathological diagnosis(Kappa value was0.617).Under white light and the NBI modes,the accuracy rate of diagnosis in high-risk endometrial lesions was81.08%and89.86%respectively(χ2=4.60,P=0.032),sensitivity was57.14%and92.86%respectively(χ2=14.29,P=0.000),negative predictive value was84.21%and96.91%(χ2=9.43,P=0.002),the difference was statistically significant in the two modes.The specificity was90.57%and88.68%respectively(χ2=0.20,P=0.652),positive predictive value was70.59%and76.47%(χ2=0.37,P=0.544).There was no significantly difference between the two modes.The diagnosis of endometrial lesions in high-risk pattern with NBI mode had good consistency with pathological diagnosis(Kappa value was0.766).Conclusion NBI can observe mucosal surface and deep microvascular morphology clearly.It could reduce the missed diagnosis of low-risk type of endometrial lesions and improve the accuracy in diagnosis of high-risk type of endometrial lesions with NBI mode.NBI is a novel and valuable technique in the diagnosis of different endometrial lesions.

关 键 词：子宫内膜增生性病变 窄带成像技术 宫腔镜 病理学诊断 

分 类 号：R711.74[医药卫生—妇产科学]