Establishment and validation of hysteroscopic scoring system for endometrial hyperplasia and carcinoma
Objective To establish a hysteroscopic scoring system and verify its predictive effectiveness to aid physi-cians 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 mul-tivariate 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 hysteros-copy at the same hospital from March 2019 to December 2019 to verify its predictive effectiveness.Results Seven mor-phological indicators,including widespread and irregular endometrial thickening,polypoid endometrial lesion,irregular lesion of the poly,abnormal endometrial color,atypical vessels,crumbling of endometrial neoplasm,and cerebroid or ar-borescent 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 re-garded as endometrial hyperplasia without atypia(EH-NA).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 provides quantitative indicators for the assessment of EH and EC,and shows a good predictive effectiveness;especially,when the score is ≥8,physcians should be alert to the presence of EC.
万方数据
维普
