A New Hysteroscopic Scoring System for Diagnosing Chronic Endometritis.
- 作者列表："Liu H","Song J","Zhang F","Li J","Kong W","Lv S","LinZhang","Yan L
STUDY OBJECTIVE:To develop a new hysteroscopic morphologic scoring system to diagnose chronic endometritis. DESIGN:A prospective study. SETTING:A medical hysteroscopy office. PATIENTS:320 patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies from February 2017 to June 2018 with the intention of undergoing assisted reproductive technology treatment due to infertility or recurrent miscarriage. INTERVENTIONS:All female patients underwent hysteroscopy, dilation and curettage, endometrial biopsies for histological examination, and were classified according to the new hysteroscopic morphologic scoring system. MEASUREMENTS AND MAIN RESULTS:One hundred and sixty four patients were diagnosed by histology to have chronic endometritis (Group A) and 156 patients were shown not to have chronic endometritis (Group B). One hundred and sixteen patients were diagnosed by our hysteroscopy scoring system to have chronic endometritis and 204 patients did not have chronic endometritis. The scoring system showed a sensitivity and specificity of 62.8% and 91.7%, respectively. The positive predictive values and negative predictive values were 88.8% and 70.1%, respectively. Receiver operating characteristic analysis showed cut-off value to be > 2 and area under the curve to be 0.823. Hysteroscopic and histologic grading showed moderate agreement (kappa index = 0.529). CONCLUSION:Our hysteroscopic scoring system has a high sensitivity and specificity for chronic endometritis and hopefully can reduce interobserver variability. Future clinical studies are warranted to confirm the validity and clinical applicability of the proposed hysteroscopic morphologic scoring system for chronic endometritis.
研究目的: 建立一种诊断慢性子宫内膜炎的宫腔镜形态学评分系统。 设计: 前瞻性研究。 单位: 一家医疗宫腔镜办公室。 患者: 320 例患者，2017年2月至 2018年6月因不孕或复发性流产，拟行辅助生殖技术治疗，行宫腔镜、扩张刮宫、子宫内膜活检。 干预措施: 所有女性患者均行宫腔镜、扩张刮宫、子宫内膜活检进行组织学检查，并根据新的宫腔镜形态学评分系统进行分级。 测量和主要结果: 156 例患者经组织学诊断为慢性子宫内膜炎 (A 组)，例患者未显示为慢性子宫内膜炎 (B 组)。204 例患者经宫腔镜检查诊断为慢性子宫内膜炎，例患者无慢性子宫内膜炎。评分系统显示的敏感性和特异性分别为 62.8% 和 91.7%。阳性预测值和阴性预测值分别为 88.8% 和 70.1%。受试者工作特性分析显示临界值> 2，曲线下面积为 0.823。宫腔镜和组织学分级显示中度一致 (kappa 指数 = 0.529)。 结论: 宫腔镜评分系统对慢性子宫内膜炎有较高的敏感性和特异性，有望降低观察者间变异性。未来的临床研究需要证实慢性子宫内膜炎宫腔镜形态学评分系统的有效性和临床适用性。
METHODS:BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.
METHODS::Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.
METHODS:STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.