Risk factors of endometrial lesions after breast cancer surgery and construction of a graph model / 中华内分泌外科杂志

Objective:To explore the risk factors affecting endometrial lesions after breast cancer surgery, and build a nomogram prediction model.Methods:From Oct. 2019 to Nov. 2021, 103 patients with abnormal bleeding after breast cancer surgery were selected, the clinical data of the patients were collected, and they were divided into the non-lesion group and the lesion group according to whether the endometrial lesion occurred. A Logistic risk regression model was established to analyze the risk factors affecting endometrial lesions in postoperative patients with breast cancer, a nomogram prediction model was constructed and verified, and receiver operating characteristic curve (ROC) analysis was performed to analyze the nomogram model for predicting sensitivityof endometrial lesions.Results:Childbirth history ( OR=37.100, 95% CI: 3.777-527.7, P=0.004), endometrial thickness ( OR=2.489, 95% CI: 1.699-4.007, P<0.001), menopause ( OR=0.099, 95% CI: 0.015-0.499, P=0.009), abnormal bleeding time ( OR=6.922, 95% CI: 2.221-24.800, P=0.002), and types of treatment drugs ( OR=3.738, 95% CI: 1.187-13.200, P=0.030) had statistical significance in predicting endometrial lesions in postoperative patients with breast cancer. Using the above five variables to construct a nomogram model, the consistency of the nomogram in predicting endometrial lesions in postoperative patients with breast cancer was 0.739, and the discrimination was good. The calibration curve showed that the average absolute error between the predicted probability and the actual probability was 0.041,and ROC curve showed that the AUC value of the nomogram model for predicting endometrial lesions was 0.800. Conclusion:Establishing a nomogram model for predicting the risk of endometrial lesions in postoperative patients with breast cancer has good accuracy and high clinical value.

Value of contrast-enhanced ultrasound in diagnosis of malignant endometrial lesions / 中华超声影像学杂志

Objective:To investigate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of malignant endometrial lesions.Methods:A total of 142 patients with endometrial lesions who underwent contrast-enhanced ultrasound examination in Beijing Tiantan Hospital, Capital Medical University from January 2019 to September 2021 were selected. The endometrial lesions were divided into benign group (including endometrial hyperplasia and endometrial polyps) and malignant group (endometrial cancer) according to the pathological results of surgery, and the differences of contrast enhancement patterns between benign group and malignant group were compared. The sensitivity, specificity of CEUS in the diagnosis of endometrial cancer were calculated, and the Kappa value was calculated with the initial enhancement time earlier than or equal to the muscularity or the peak time earlier than the muscularity as the diagnostic index for the diagnosis of endometrial malignant lesions. The sensitivity, specificity, and Kappa value of CEUS in the diagnosis of endometrial cancer and endometrial cancer with thickness ≥10 mm were calculated.Results:A total of 108 patients underwent surgery with clear pathological results, including 66 patients in the benign lesion group and 42 patients in the malignant lesion group. The thickness of malignant lesions was significantly larger than that of benign lesions, and the difference was statistically significant( t=4.039, P<0.05), but there was no significant difference of hemodynamic parameters between the two groups ( P>0.05). The initial enhancement time, peak time and peak intensity of benign lesions were significantly different from those of malignant lesions(all P<0.05). The sensitivity, specificity, and Kappa value of CEUS in the diagnosis of endometrial cancer were 64.3%, 100% and 0.668, respectively. The sensitivity, specificity and Kappa value of CEUS in the diagnosis of endometrial carcinoma with lesion thickness ≥10 mm were 75.0%, 100% and 0.795, respectively. Conclusions:For the diagnosis of endometrial lesions, especially the malignant endometrial lesions with thickness and diameter greater than or equal to 10mm, there is a high diagnostic coincidence rate between CEUS and pathological diagnosis, and endometrial malignant lesions have more specific CEUS manifestations.

Progresses of ultrasound elastography in endometrial lesions / 中国医学影像技术

Endometrial lesions are common gynecological diseases in women,including submucosal fibroids,endometrial polyps,endometrial hyperplasia and endometrial cancer,etc.Endometrial hyperplasia is one of the precancerous lesions,and early diagnosis can effectively reduce the rate of malignancy.Ultrasound elastography has been gradually used in gynecology.The classification,principles of ultrasound elastography and its application in diagnosis of endometrial lesions were reviewed in the article.

Clinical value of hysteroscopy with narrow-band imaging in diagnosis of different endometrial lesions / 中国内镜杂志

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 diagnosis in 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.

Accuracy of Endometrial Sampling Device in Diagnosing Endometrial Lesions by Cytology / 中国微创外科杂志

Objective To probe into the diagnostic accuracy of endometrial sampling device in the detection of endometrial lesions by cytology. Methods Endometrial cytological examination was performed on totally 193 out-patients from January to May 2008,the results were compared with the histological results by diagnostic curettage (D&C). Results The sampling qualified rate of endometrial sampling device was 93.8% (181/193) while that of D&C was 99.0% (191/193,?2=7.412,P=0.006). Thirteen patients were diagnosed with endometrial malignant lesions by D&C. In these patients,the sensitivity and specificity of cytology was 69.2% (9/13) and 100.0% (166/166),respectively;and its accuracy rate was 97.8% (175/179). By D&C 18 patients were diagnosed with endometrial hyperplasia,in whom the sensitivity and specificity of cytology was 27.8% (5/18) and 98.8% (159/161),respectively,and the accuracy rate was 91.6% (164/179). Ten patients were confirmed as having endometrial benign lesions without hyperplasia by D&C,for whom the sensitivity and specificity of cytology was 60.0% (6/10) and 98.8% (167/169) respectively,and the accuracy rate was 96.6% (173/179). The accuracy rate of endometrial cytological examination for 80 infertility patients with satisfactory sample was 100%,when the main objective was to determine whether the endometrial gland secreted or not. Conclusion Cytological examination by endometrial sampling device is feasible in the detection of endometrial malignant lesions and inspection of endometrium for infertility patients,but further discussion is necessary in the detection of endometrial benign lesions.