A Systematic Review of Tissue Sampling Techniques for the Diagnosis of Adenomyosis
| Autor: | Peter Movilla, S.N. Morris, Keith B. Isaacson |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Image-Guided Biopsy
medicine.medical_specialty Percutaneous medicine.medical_treatment Hysteroscopy Hysterectomy Sensitivity and Specificity Specimen Handling 03 medical and health sciences 0302 clinical medicine Pregnancy Biopsy medicine Humans Sampling (medicine) Adenomyosis Laparoscopy Ultrasonography 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Pelvic pain Biopsy Needle Obstetrics and Gynecology medicine.disease Infertility 030220 oncology & carcinogenesis Myometrium Female Radiology medicine.symptom business |
| Zdroj: | Journal of Minimally Invasive Gynecology. 27:344-351 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2019.09.001 |
| Popis: | Objective Evaluate the accuracy of tissue sampling techniques for the diagnosis of adenomyosis. Data sources Systematic Review via MEDLINE and the Cochrane Library searches. Methods of study selection Review performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing MeSH terms and keywords including "Adenomyosis/diagnosis" or "Adenomyosis/pathology" or "Myometrium/pathology" and "Biopsy" or "Hysteroscopy" or "Laparoscopy." Articles initially screened by title and abstract to include relevant studies with reference lists cross-referenced to find additional studies. Articles related to the diagnosis of uterine malignancy or studies in which tissue sampling was obtained through excisional surgical procedures were excluded from the review. Tabulation, integration, and results Fourteen studies were identified describing tissue sampling techniques to diagnose adenomyosis, with a total of 1909 patients, from 12 different countries, involving 6 different continents. Tissue sampling techniques were categorized based on (1) biopsy approach as either intrauterine and extrauterine and (2) techniques that were validated or not validated with a confirmatory hysterectomy pathology. Overall, there was significant heterogeneity in the tissue sampling techniques including intrauterine sampling obtained through hysteroscopic biopsy or resection and extrauterine tissue sampling obtained with needle biopsy by a percutaneous, transvaginal, laparoscopic, or ex-vivo approach. Sensitivity of these techniques varied significantly based on technique, tissue sampling location and the number of biopsies obtained, and was as low as 22.2% for an ultrasound-guided transvaginal biopsy of suspicious uterine lesions (4 biopsies per patient) and was as high as 97.8% for a laparoscopic guided myometrial biopsy of suspicious uterine lesions (10 biopsies per patient). Specificity for the identified tissue sampling techniques was more homogeneous ranging from 78.5% to 100% for all methods identified. The positive predictive value and negative predictive value ranges were 75.9% to 100% and 46.4% to 80% respectively among all tissue sampling techniques identified with confirmatory hysterectomy pathology. Conclusion Because of the heterogeneity of the tissue sampling techniques, diverse patient populations, and significant conflicting recommendations, no conclusive recommendation on the optimal tissue sampling technique can be made. However, it would be reasonable to limit uterine tissue sampling for confirmatory diagnosis of adenomyosis in patients with a suspicion of adenomyosis based on both symptom profile and pelvic ultrasound, where a planned diagnostic laparoscopy for either infertility or pelvic pain has already been contemplated and scheduled, and where the confirmatory results may be of clinical benefit in discussing the prognosis of recurrent postoperative symptoms and guide any future treatment recommendations. |
| Databáze: | OpenAIRE |
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