探讨宫腔镜窄带成像技术(NBI)在子宫内膜增生症(EH)及子宫内膜癌诊断中的应用价值。

选择2015年6月至2017年1月，因子宫异常出血(AUB)、不孕症及超声检查结果提示子宫内膜回声不均的可疑子宫内膜病变，于十堰市太和医院进行宫腔镜检查的419例患者为研究对象。所有患者均接受宫腔镜普通白光成像技术(WLI)与NBI检查，以及子宫内膜活组织病理学检查，诊断子宫内膜病变。以子宫内膜活组织病理学检查为"金标准"，分别计算宫腔镜WLI与NBI诊断EH及子宫内膜癌的敏感度、特异度，以及这2种检查诊断EH病理分型的敏感度，并采用χ²检验进行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求，征得所有受试者知情同意，并签订知情同意书。

①采取宫腔镜WLI与NBI对EH及子宫内膜癌诊断：Kappa值分别为0.793、0.843；敏感度分别为83.5%(111/133)、91.7%(122/133)，特异度分别为94.8%(271/286)、93.7%(268/286)。宫腔镜NBI诊断EH及子宫内膜癌的敏感度，显著高于宫腔镜WLI，并且差异有统计学意义(χ²＝4.186，P＝0.041)；而二者特异度比较，差异无统计学意义(χ²＝0.289，P＝0.591)。②采取宫腔镜WLI与NBI对EH病理分型诊断：敏感度分别为66.9%(89/133)、71.4%(95/133)，二者比较，差异无统计学意义(χ²＝0.635，P＝0.426)。③采取宫腔镜WLI，可见EH患者子宫内膜表面凹凸不平或局灶性增厚，部分区域呈"筛孔状"改变，偶见细小血管分布；而宫腔镜NBI，可见EH患者被增厚子宫内膜遮挡的血管呈"树枝状"或"网状"分布，走行较为规则，血管粗细较为均匀，未见明显粗大血管。宫腔镜WLI检查可见子宫内膜癌患者的子宫内膜形态改变，而且增厚子宫内膜呈"脑回样"或"分叶状"改变，子宫内膜表面毛糙似绒毛样，质地糟脆，并且可见粗大、裸露血管，而且血管粗细不一，部分可见瘤样或青蛙卵状血管；宫腔镜NBI则可见上述血管病变更为明显。

宫腔镜NBI诊断EH及子宫内膜癌的敏感度高于宫腔镜WLI，但是对EH病理分型诊断的敏感度，宫腔镜WLI与NBI无差异。对于子宫内膜癌的诊断，宫腔镜NBI较WLI检查并无更多获益。子宫内膜存在炎症、广泛充血或病变有活动性出血时，宫腔镜NBI诊断子宫内膜病变受到限制。

To explore the values of narrow-band imaging (NBI) hysteroscopy in the diagnosis of endometrial hyperplasia (EH) and endometrial cancer.

From June 2015 to January 2017, a total of 419 cases of patients who received hysteroscopy due to abnormal uterine bleeding (AUB) and infertility, the results of ultrasound showed that the endometrium echo was uneven and suspected endometrial lesions in Taihe Hospital of Shiyan City were selected as research subjects. Endometrial lesions of all patients were observed by ordinary white light imaging (WLI) and NBI hysteroscopy, and endometrium biopsy. The sensitivities and specificities of WLI and NBI hysteroscopy in the diagnosis of EH and endometrial cancer, and the sensitivities of these two different modes in the diagnosis of pathological classifications of EH were calculated as the diagnosis of endometrium biopsy was " gold standard" . And the sensitivities and specificities of WLI and NBI hysteroscopy were compared by chi-square test. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtained from every subject and every subject signed the informed consent form.

Endometrium biopsy was used as the " gold standard" for clinical diagnosis of endometrial lesions. ①WLI and NBI hysteroscopy for the diagnosis of EH and endometrial cancer: the Kappa values were 0.793 and 0.843, respectively; the sensitivities were 83.5% (111/133) and 91.7% (122/133), respectively; the specificities were 94.8% (271/286) and 93.7% (268/286), respectively. The sensitivity of NBI hysteroscopy in the diagnosis of EH and endometrial cancer was higher than that of WLI hysteroscopy, and the difference was statistically significant (χ²=4.186, P=0.041). However, for the comparison of specificities, the difference was not statistically significant (χ²=0.289, P=0.591). ②WLI and NBI hysteroscopy for the diagnosis of pathological classifications of EH: the sensitivities were 66.9% (89/133) and 71.4% (95/133), respectively, and the difference was not statistically significant (χ²=0.635, P=0.426). ③EH showed uneven or focal thickening on the surface of endometrium under WLI hysteroscopy, with ethmoidal changes in some areas, and occasional distribution of small blood vessels on the surface of endometrium. EH showed a branch or reticular distribution of the thickened endometrium, with a relatively regular shape, relatively uniform blood vessel and no obvious large blood vessels was found under NBI hysteroscopy. Endometrial cancer showed morphologic changes in endometrium, thickening endometrium as gyrus or lobular changes under WLI hysteroscopy, and the surface of endometrium was as rough as the villi, and the texture was bad and crisp under WLI hysteroscopy. Large, naked blood vessels with different diameters, and tumor-like or frog oval blood vessels could be found in endometrial cancer under WLI hysteroscopy. The changes of blood vessels mentioned above were more obvious under NBI hysteroscopy.

NBI hysteroscopy is more sensitive than WLI hysteroscopy in the diagnosis of EH and endometrial cancer, but there is no difference in the sensitivity of the diagnosis of pathological classifications of EH by WLI and NBI hysteroscopy. For the diagnosis of endometrial cancer, NBI hysteroscopy does not benefit more than ordinary WLI hysteroscopy. NBI hysteroscopy will be limited in the diagnosis of endometrial lesion when there is inflammation, extensive congestion or active bleeding in the endometrium.