子宫内膜增生及子宫内膜癌的宫腔镜评分系统构建与验证  

Establishment and validation of hysteroscopic scoring system for endometrial hyperplasia and carcinoma

作　　者：李小燕 蒯丹 田欢 张慧霞 田文艳[1] 张艳芳[1] 王颖梅[1] 薛凤霞[1] 张慧英[1] LI Xiao-yan;KUAI Dan;TIAN Huan;ZHANG Hui-xia;TIAN Wen-yan;ZHANG Yan-fang;WANG Ying-mei;XUE Fengxia;ZHANG Hui-ying(Department of Gynecology and Obstetrics,Tianjin Medical University General Hospital&Tianjin Key Laboratory of Female Reproductive Health and Eugenics,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院妇产科天津市女性生殖健康与优生重点实验室,天津300052

出　　处：《中国实用妇科与产科杂志》2024年第1期96-100,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：天津市科技计划项目(18ZXDBSY00220);国家自然科学基金(82172626)。

摘　　要：目的构建子宫内膜增生(endometrial hyperplasia,EH)及子宫内膜癌(endometrial carcinoma,EC)的宫腔镜评分系统并验证其预测效能,帮助不同宫腔镜手术经验医师进行初步评估。方法收集2017年9月至2019年1月于天津医科大学总医院妇产科行宫腔镜检查及子宫内膜活检的288例患者的临床资料,对其宫腔镜影像进行评估以识别EH和EC的形态学指标。通过有序多分类logistic回归分析,选择显著参数并以标准化系数赋分。采用受试者工作特征曲线(ROC)划分评分区间,初步构建宫腔镜评分系统。随后将该评分应用于2019年3月至2019年12月在同一医院行宫腔镜检查的276例患者,验证评分系统的预测效能。结果子宫内膜广泛不规则增厚、内膜息肉样变、不规则息肉样变、内膜颜色异常、异型血管、肿物坏死破溃、肿物脑回路样或树枝状生长7种形态学指标被纳入评分系统。宫腔镜评分系统总分值28分,ROC曲线显示评分2~4分提示子宫内膜增生不伴不典型增生(EHNA);评分5~7分,提示不典型增生(AH);评分≥8分时,考虑EC。该评分系统预测EHNA的敏感度、特异度、PPV和NPV分别为78.69%、93.15%、82.76%、91.28%;预测AH的敏感度、特异度、PPV和NPV分别为89.47%、94.30%、65.38%和98.68%;预测EC的敏感度、特异度、PPV和NPV分别为90.00%、100.00%、100.00%和97.14%。结论构建的该宫腔镜评分系统为评价EH和EC提供了量化指标,具有良好的预测效果,尤其是当评分≥8分时,应警惕EC的存在。Objective To establish a hysteroscopic scoring system and verify its predictive effectiveness to aid physicians with different experience levels to make a preliminary evaluation of endometrial hyperplasia(EH)and carcinoma(EC).Methods Clinical data of 288 patients who underwent hysteroscopy and biopsy in the Department of Gynecology and Obstetrics of Tianjin Medical University General Hospital from September 2017 to January 2019 were collected,and the videos of diagnostic hysteroscopy before biopsies were evaluated to recognize morphologic parameters in EH and EC.Significant parameters were selected and assigned a score according to standardized coefficients through the ordinal multivariate Logistic analysis.Score intervals were created by receiver operating characteristic curve(ROC)to construct the preliminary scoring system of hysteroscopy.Then the scoring system was applied to 276 women who underwent hysteroscopy at the same hospital from March 2019 to December 2019 to verify its predictive effectiveness.Results Seven morphological indicators,including widespread and irregular endometrial thickening,polypoid endometrial lesion,rregular lesion of the poly,abnormal endometrial color,atypical vessels,crumbling of endometrial neoplasm,and cerebroid or arborescent growth of mass,were included in the scoring system.The total score of the hysteroscopy scoring system was 28,and ROC curve showed that the score of 2 to 4 was regarded as endometrial hyperplasia without atypia(EHNA).A score of 5 to 7 indicated atypical hyperplasia(AH),and the score≥8 suggested the diagnosis of EC.The sensitivity,specificity,PPV,and NPV of the scoring system in predicting EHNA was 78.69%,93.15%,82.76%,and 91.28%,respectively.The sensitivity,specificity,PPV,and NPV of the system in predicting AH was 89.47%,94.30%,65.38%,and 98.68%,respectively.For the prediction of EC,the sensitivity,specificity,PPV,and NPV of the system was 90.00%,100.00%,100.00%,and 97.14%,respectively.Conclusion Hysteroscopic scoring system established in this study pro

关 键 词：子宫内膜增生 子宫内膜癌 宫腔镜 评分系统 预测价值 

分 类 号：R711[医药卫生—妇产科学]