Alex Kalendaryov, Avishalom Sharon, Inshirah Sgayer, Susana Mustafa Mikhail, Lior Lowenstein, Ala Aiob
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This study aimed to assess the diagnostic accuracy of transvaginal ultrasound (TVS) endometrial thickness measurements for identifying RPOC and propose tailored hysteroscopic management strategies.</p><p><strong>Design: </strong>This is a retrospective cohort study.</p><p><strong>Participants and setting: </strong>A total of 226 women with suspected RPOC underwent hysteroscopy between 2018 and 2021 at the Galilee Medical Center.</p><p><strong>Methods: </strong>Endometrial thickness was measured by TVS, and diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated.</p><p><strong>Results: </strong>The mean endometrial thickness was 1.6 cm (0.7-6 cm). The overall PPV for RPOC was 79.2%, with a false-positive rate of 20.7%. A cut-off of 1.49 cm yielded a sensitivity of 69.8%, specificity of 59.6%, PPV of 86.8%, and NPV of 34.1%. Women with thickness >1.49 cm had a threefold increased likelihood of RPOC. 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引用次数: 0
摘要
目的:妊娠残留产物(RPOC)可发生在分娩、流产或子宫排出后,这给诊断带来了挑战。本研究旨在评估经阴道超声(TVS)子宫内膜厚度测量诊断RPOC的准确性,并提出量身定制的宫腔镜治疗策略。设计:回顾性队列研究参与者和背景:2018年至2021年间,共有226名疑似RPOC的女性在加利利医疗中心接受了宫腔镜检查。方法:采用TVS测量子宫内膜厚度,计算诊断指标,包括敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。结果:子宫内膜平均厚度为1.6 cm (0.7 ~ 6 cm)。RPOC的总PPV为79.2%,假阳性率为20.7%。截止值为1.49 cm,敏感性为69.8%,特异性为59.6%,PPV为86.8%,NPV为34.1%。厚度为1.49 cm的女性患RPOC的可能性增加了三倍。子宫内膜厚度分层显示PPVs为54.5% (20mm)。局限性:回顾性设计可能引入选择偏倚,研究结果需要在更大的前瞻性研究中验证。结论:子宫内膜厚度大于1.49 cm显著增加RPOC确诊的可能性。RPOC可发生在有相关危险因素的无症状妇女。TVS子宫内膜厚度测量对诊断和治疗这些病例是有效的,分层进一步提高了诊断的准确性。
Diagnostic Accuracy of Endometrial Thickness in Identifying Retained Products of Conception and Tailored Hysteroscopic Management: A Retrospective Study.
Objectives: Retained products of conception (RPOC) can occur after delivery, abortion, or uterine evacuation, presenting diagnostic challenges. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound (TVS) endometrial thickness measurements for identifying RPOC and propose tailored hysteroscopic management strategies.
Design: This is a retrospective cohort study.
Participants and setting: A total of 226 women with suspected RPOC underwent hysteroscopy between 2018 and 2021 at the Galilee Medical Center.
Methods: Endometrial thickness was measured by TVS, and diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated.
Results: The mean endometrial thickness was 1.6 cm (0.7-6 cm). The overall PPV for RPOC was 79.2%, with a false-positive rate of 20.7%. A cut-off of 1.49 cm yielded a sensitivity of 69.8%, specificity of 59.6%, PPV of 86.8%, and NPV of 34.1%. Women with thickness >1.49 cm had a threefold increased likelihood of RPOC. Stratifying by endometrial thickness showed PPVs of 54.5% (<10 mm), 76.5% (10-20 mm), and 98.0% (>20 mm).
Limitations: Retrospective design may introduce selection bias, and findings require validation in larger, prospective studies.
Conclusions: An endometrial thickness above 1.49 cm significantly increases the likelihood of RPOC confirmation. RPOC can occur in asymptomatic women with associated risk factors. TVS endometrial thickness measurements are effective for diagnosing and managing these cases, and stratification further enhances diagnostic accuracy.
期刊介绍:
This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.