TVS可有效诊断子宫腺肌病和平滑肌瘤

圣迭戈——在美国外科医师协会/国家外科质量改进计划(ACS/NSQIP)全国大会上报告的一项单中心研究表明，经阴道超声(TVS)可有效用于子宫平滑肌瘤以及子宫腺肌病合并平滑肌瘤的诊断，其准确性、敏感性和特异性都较高。

美国亚特兰大Saint Joseph医院妇产科主任Magdi Hanafi医生在会后接受采访时称：“月经过多在女性中非常常见，每个月都会给女性带来数天的烦恼。它会影响患者正常的生活和工作，并且可能导致贫血及其后续并发症。月经过多的两大病因分别是子宫腺肌病和平滑肌瘤。但仅仅根据临床表现甚至有时候在盆腔超声检查中，一些妇科医生常会漏诊这两种疾病，特别是子宫腺肌病。”


Magdi Hanafi医生

Hanafi博士对163例经术前TVS诊断为子宫腺肌病、平滑肌瘤以及子宫腺肌病合并平滑肌瘤的患者进行了回顾性分析。在这163例患者中，130例接受了子宫切除术，33例有症状的患者接受了子宫肌瘤剔除术加周围子宫肌层(疑似含子宫腺肌病)切除术。术后，医院病理科医生对患者进行了组织学检查并记录了诊断。

患者的平均年龄为44岁。Hanafi医生报告称，123例患者经TVS诊断为子宫腺肌病，其中93例患者(76%)经组织病理学检查确诊为子宫腺肌病，30例(24%)为阴性。因此，TVS诊断子宫腺肌病的敏感性、特异性和准确性分别为85%(P＜0.0001)、43%(P=0.41)和71%。“这提示TVS诊断子宫腺肌病的敏感性较高，但特异性较低。”

共有134例患者有完整的子宫平滑肌瘤组织病理学数据。其中133例患者(99%)经组织病理学检查确诊为子宫平滑肌瘤，1例(1%)为阴性。因此，TVS诊断子宫平滑肌瘤的敏感性、特异性和准确性分别为96%(P＜0.0001)、96%(P＜0.0001)和96%。

Hanafi博士指出：“在其他已发表的关于子宫腺肌病诊断的文献中，子宫腺肌病合并平滑肌瘤的情况很少被提及。但其实这种合并症比我们以前认为的要普遍得多，所有妇科医生在对月经过多患者进行鉴别诊断时都应该考虑到这种情况。”

Hanafi博士总结道：“诊室TVS对于子宫腺肌病、子宫平滑肌瘤或者子宫腺肌病合并平滑肌瘤是一种非常有价值的检测手段。它诊断子宫平滑肌瘤、子宫腺肌病或者两者合并的敏感性和准确性都较高，只是诊断子宫腺肌病的特异性较差。”

Hanafi博士声明无相关经济利益冲突。

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TVS useful for diagnosis of adenomyosis and leiomyoma

By: DOUG BRUNK, Internal Medicine News Digital Network

SAN DIEGO – Transvaginal ultrasound is accurate, sensitive, and specific in the diagnosis of leiomyoma and coexisting adenomyosis and leiomyoma, results from a single-center study showed.

"Menorrhagia is a very common condition which female patients are suffering from many days of the month," Dr. Magdi Hanafi, FACS, said in an interview after the American College of Surgeons/National Surgical Quality Improvement Program National Conference, where the study was presented at a poster session.

"It interferes with their normal day-to-day life and work, and causes anemia and its subsequent complications. Two of the common causes of menorrhagia are adenomyosis and leiomyoma. These two conditions are frequently missed by some gynecologists – especially adenomyosis – clinically and on some occasions by pelvic ultrasound."
 
Dr. Hanafi, medical director of Gyn. and Fertility Specialists at Saint Joseph’s Hospital of Atlanta, retrospectively evaluated 163 women with a preoperative transvaginal ultrasound (TVS) diagnosis of adenomyosis, leiomyoma, and adenomyosis with coexisting leiomyoma. Of the 163 patients, 130 underwent hysterectomy and 33 symptomatic patients underwent myomectomy with excision of the surrounding myometrium, which presumably contained adenomyosis. Following surgery, hospital pathologists performed a histological examination and recorded the diagnosis.

The mean age of the patients was 44 years. Dr. Hanafi reported that 123 of the patients were positively diagnosed with adenomyosis via TVS. Among these, histopathologic confirmation of TVS diagnosis of adenomyosis was positive in 93 patients (76%) and negative in 30 (24%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of adenomyosis were 85% (P less than .0001), 43% (P = .41), and 71%, respectively. "This demonstrates that TVS diagnosis of adenomyosis is sensitive, but not specific," he said.

Histopathologic data on leiomyoma was complete in 134 of the patients. Among these, histopathologic confirmation of TVS diagnosis of leiomyoma was positive in 133 patients (99%) and negative in 1 (1%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of leiomyoma were 96% (P less than .0001), 96% (P less than .0001), and 96%, respectively.

"In other published studies in the diagnosis of adenomyosis, combined adenomyosis and leiomyoma was not mentioned," Dr. Hanafi commented. "This combination is more common than we ever thought before, and all gynecologists should think of this combined condition in menorrhagic patients in their differential diagnosis."

He concluded that office TVS "is a very valuable procedure in the diagnosis of adenomyosis, leiomyoma, or combined [adenomyosis and leiomyoma]. It is sensitive and accurate in the diagnosis of leiomyoma, adenomyosis, or [the combination], but not specific in the diagnosis of adenomyosis alone."

Dr. Hanafi said that he had no relevant financial conflicts to disclose.