DOI：10.12201/bmr.202308.00002

Vaginal ultrasound and hysteroscopy for the diagnosis of abnormal uterine bleeding

• 摘要：目的：探讨阴道超声与宫腔镜诊断围绝经期异常子宫出血的价值。方法：回顾性选取新疆医科大学第二附属医院2021年9月－ 2023年3月在围绝经期因异常子宫出血均行宫腔镜与阴道超声检查的176例妇女，具备明确病理诊断结果。结果：病理诊断结果与阴道超声诊断结果具有统计学差异(P＜0.05), Kappa值为0.475，一致性效果一般。病理诊断结果与宫腔镜诊断结果具有统计学差异(P＜0.05), Kappa值为0.669，一致性效果较好。两种联合诊断的Kappa值为0.784,一致性效果更好，提示两种联合诊断效果更好。对围绝经期异常子宫出血诊断,阴道超声的灵敏度89.7%表现尚可,特异度66.7%与阴性预测值46.7%均较低；宫腔镜诊断灵敏度与特异度分别为94.8%和76.2%，均较单纯阴道超声检查升高，但阴性预测值为66.7%，仍然较低。两种联合诊断灵敏度与特异度分别为97.4%和81.0%，而且阴性预测值为81.0%，均较单独阴道超声及宫腔镜的诊断效能提高。在对子宫内膜息肉引起的ABU病因诊断中, 宫腔镜的符合率为93.3%，高于阴道超声的77.3%，差异有统计学意义（χ2 =7.670，P=0.006），宫腔镜的检测效能更高。结论：阴道超声和宫腔镜在围绝经期AUB的病因诊断中均有一定的诊断价值，阴道超声是安全且相对便宜的方法，在AUB病因的初筛占有优势。但还是存在漏诊，误诊等风险。宫腔镜虽然价格昂贵，便利性低，但宫腔镜结合病理检查有助于提高癌及癌前病变的检出率，继而明确AUB病因，尽早治疗，值得推广。

  关键词： 子宫; ABU; 宫腔镜; 阴道超声; 围绝经期异常子宫出血

   

  Abstract: Objactive: To investigate the value of vaginal ultrasound and hysteroscopy in the diagnosis of perimenopausal abnormal uterine bleeding. Methods: A total of 176 women who underwent hysteroscopy and vaginal ultrasound for abnormal uterine bleeding during perimenopause from September 2021 to March 2023 in the Second Affiliated Hospital of Xinjiang Medical University were retrospectively selected, with clear pathological diagnostic results. Results: The pathological findings were statistically different from those of vaginal ultrasound (P < 0.05), with a kappa value of 0.475, which was generally consistent. There was a statistical difference between the pathological diagnosis and hysteroscopic diagnosis (P < 0.05), and the Kappa value was 0.669, with a good agreement effect. The Kappa value of the two combined diagnoses was 0.784, with the better agreement, suggesting that the two combined diagnoses are more effective. For the diagnosis of perimenopausal abnormal uterine bleeding, the sensitivity of vaginal ultrasound was 89.7%, but the specificity of 66.7% and the negative predictive value of 46.7% were both low; the sensitivity and specificity of hysteroscopy were 94.8% and 76.2%, respectively, which were higher than those of vaginal ultrasound alone, but the negative predictive value of 66.7% was still low. The sensitivity and specificity of the two combined diagnoses were 97.4% and 81.0%, respectively, and the negative predictive value was 81.0%, both of which improved the diagnostic efficacy compared with vaginal ultrasound and hysteroscopy alone. In the etiological diagnosis of ABU due to endometrial polyps, the hysteroscopic compliance rate was 93.3%, which was higher than that of vaginal ultrasound (77.3%), and the difference was statistically significant (χ2 =7.670, P=0.006), and the detection efficacy of hysteroscopy was higher. Conclusion: Both vaginal ultrasound and hysteroscopy have some diagnostic value in the diagnosis of the etiology of perimenopausal AUB, and vaginal ultrasound is a safe and relatively inexpensive method that holds an advantage in the primary screening of the etiology of AUB. However, there is still a risk of missed diagnosis and misdiagnosis. Although hysteroscopy is expensive and less convenient, hysteroscopy combined with pathological examination can help improve the detection rate of cancer and precancerous lesions, and then clarify the cause of AUB and treat it as early as possible, which is worth promoting.

  Key words: uterus; ABU; hysteroscopy; vaginal ultrasound; abnormal uterine bleeding during perimenopause

  提交时间：2023-09-12

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• 序号	提交日期	编号	操作
  1	2023-08-29	bmr.202308.00002V1	下载

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