European journal of obstetrics, gynecology, and reproductive biology · 2026
Development of predictive models for endometrial outcomes in patients with intrauterine adhesions post-hysteroscopic adhesiolysis: evaluating endometrial vascularization through narrow-band imaging hysteroscopy and Doppler ultrasound.
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Huang Jiezhuang, Huang Yanlan, Chen Shengcai, Ye Qing, Liang Shuang, Wei Caini, Zhi Zhifu
Аннотация
OBJECTIVE: This study aimed to investigate the potential of narrow-band imaging (NBI) hysteroscopy and 2-Dimensional (2-D) ultrasound in predicting re-adhesion for patients with intrauterine adhesions (IUAs) following transcervical resection of adhesions (TCRA).
DESIGN: Retrospective study.
PATIENTS: We included 56 patients diagnosed with IUAs who underwent TCRA with NBI hysteroscopy at the First Affiliated Hospital of Guangxi medical university from June 2020 to February 2023.
INTERVENTIONS: Participants were divided into two groups based on their endometrial recovery during a three-month follow-up after TCRA: a recovery group (n = 42) and a poor recovery group (n = 14). Both univariable and multivariable logistic regression analyses were conducted to identify independent factors impacting postoperative outcomes. Subsequently, nomogram prediction models were constructed and internally validated using the identified independent factors in conjunction with the classifications established by the European Society of Gynecological Endoscopy (ESGE) and the American Fertility Society (AFS).
MAIN OUTCOME MEASURES: Endometrial restoration within the 3-month follow-up after TCRA.
RESULTS: A higher endometrial microvascular index assessed by NBI hysteroscopy and enhanced endometrial blood flow in zone 3, as measured by 2-D Doppler ultrasound, were identified as independent protective factors for postoperative endometrial recovery. The identified factors, when combined with ESGE or AFS classifications, were utilized to build nomogram prediction models, referred to as the NUE and NUA models, respectively. The NUE model (AUC = 0.935, 95% CI: 0.865-1.000) and the NUA model (AUC = 0.939, 95% CI: 0.876-1.000) demonstrated superior discrimination compared to the ESGE (AUC = 0.651, 95% CI: 0.490-0.813) and AFS classifications (AUC = 0.736, 95% CI: 0.578-0.893) alone. The calibration curve indicated that the NUA model exhibited greater consistency between predicted and actual outcomes than the NUE model.
CONCLUSION: Endometrial vascularity is a critical factor for postoperative endometrial recovery in IUAs patients following TCRA. NBI hysteroscopy and Doppler ultrasound provide significant advantages in evaluating endometrial blood vessels, thereby facilitating accurate predictions of endometrial outcomes.
DESIGN: Retrospective study.
PATIENTS: We included 56 patients diagnosed with IUAs who underwent TCRA with NBI hysteroscopy at the First Affiliated Hospital of Guangxi medical university from June 2020 to February 2023.
INTERVENTIONS: Participants were divided into two groups based on their endometrial recovery during a three-month follow-up after TCRA: a recovery group (n = 42) and a poor recovery group (n = 14). Both univariable and multivariable logistic regression analyses were conducted to identify independent factors impacting postoperative outcomes. Subsequently, nomogram prediction models were constructed and internally validated using the identified independent factors in conjunction with the classifications established by the European Society of Gynecological Endoscopy (ESGE) and the American Fertility Society (AFS).
MAIN OUTCOME MEASURES: Endometrial restoration within the 3-month follow-up after TCRA.
RESULTS: A higher endometrial microvascular index assessed by NBI hysteroscopy and enhanced endometrial blood flow in zone 3, as measured by 2-D Doppler ultrasound, were identified as independent protective factors for postoperative endometrial recovery. The identified factors, when combined with ESGE or AFS classifications, were utilized to build nomogram prediction models, referred to as the NUE and NUA models, respectively. The NUE model (AUC = 0.935, 95% CI: 0.865-1.000) and the NUA model (AUC = 0.939, 95% CI: 0.876-1.000) demonstrated superior discrimination compared to the ESGE (AUC = 0.651, 95% CI: 0.490-0.813) and AFS classifications (AUC = 0.736, 95% CI: 0.578-0.893) alone. The calibration curve indicated that the NUA model exhibited greater consistency between predicted and actual outcomes than the NUE model.
CONCLUSION: Endometrial vascularity is a critical factor for postoperative endometrial recovery in IUAs patients following TCRA. NBI hysteroscopy and Doppler ultrasound provide significant advantages in evaluating endometrial blood vessels, thereby facilitating accurate predictions of endometrial outcomes.