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*

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（χ2 =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% （χ2 =4.60，P =0.032），敏感性分别为57.14% 及92.86%（χ2 =14.29，P =0.000），阴性预测值分别为84.21% 及 96.91%（χ2 =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%（χ2 =0.20， P =0.652）， 阳性预测值分别为70.59% 及76.47%（χ2 =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。

Abstract:

Objective To study the clinical value of hysteroscopy with narrow-band imaging (NBI) in diagnosis of different endometrial lesions. Methods 148 patients 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 was 65.52% and 86.21% 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 was 0.617). Under white light and the NBI modes, the accuracy rate of diagnosisin high-risk endometrial lesions was 81.08% and 89.86% respectively (χ2 = 4.60, P = 0.032), sensitivity was 57.14% and 92.86% respectively (χ2 = 14.29, P = 0.000), negative predictive value was 84.21% and 96.91% (χ2 = 9.43, P = 0.002), the difference was statistically significant in the two modes. The specificity was 90.57% and 88.68% respectively (χ2 = 0.20, P = 0.652), positive predictive value was 70.59% and 76.47% (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 was 0.766). 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.