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他们发现如果不能从组织学上除外自然流产，髙达40%的异位妊娠诊断错误。They found that the presumptive diagnosis of ectopic pregnancy is inaccurate in nearly 40 percent of cases without histologic exclusion of a spontaneous pregnancy loss.
然而,尚缺乏有效的评价子宫内膜取样的时机和方式的研究。Nevertheless, the need and method of endometrial sampling must carefully be weighed against the limited risks of methotrexate.
有研究Pipelle活检是否可作为刮宫术的替代,发现其取得绒毛的敏感性为30%-63% (Barnhart, 2003b;Ries,2000)。Pipelle biopsy was studied as an alternative to curettage and found inferior, with sensitivity of obtaining villi ranging from 30 to 63 percent (Barnhart, 2003b; Ries, 2000).
与此对比，用刮宫取得组织的冷冻切片确定妊娠产物的准确性要超过90% (Barak， 2005 ；Spandorfer, 1996)。By comparison, frozen section of curettage fragments to identify products of conception is accurate in over 90 percent of cases (Barak, 2005; Spandorfer, 1996).
新的血清标志物Novel Serum Markers
有一些小规模的研究来评价新的、诊断异位妊娠的标志物。A number of small studies have been done to evaluate the utility of novel markers to detect ectopic pregnancy.
Daniel等（1999)发现血管内皮生长因子(vascular endothelial growth factor, VEGF)的浓度〉 200 pg/L可以用来鉴别诊断异位妊娠和正常或死亡的宫内妊娠，其敏感性、特异性和阳性预测值分别为 60%、90%和86%。Daniel and associates (1999) found that vascular endothelial growth factor (VEGF) in concentrations <200 pg/mL could differentiate between an ectopic and a normal or arrested uterine pregnancy with a sensitivity, specificity, and positive predictive value of 60, 90, and 86 percent, respectively.
此外，还有学者研究癌抗原125 (cancer
antigen 125，CA125)、血清肌酸激酶和胎儿纤维连接蛋白浓度作为异位妊娠的标志物（NeSS 1998;Predanic,2000)。In addition, cancer antigen 125 (CA 125), serum creatine kinase, and fetal fibronectin concentrations have been investigated (Ness, 1998; Predanic, 2000).
近日，质谱为基础的蛋白质组学技术也被用来确定正常妊娠和它的一些疾病（尚卡尔，2005年）的生化蓝图。Recently, mass spectrometry-based proteomic techniques have also been used to determine the biochemical blueprint of normal pregnancy and some of its disorders (Shankar, 2005).
诊断评价总结Summary of Diagnostic Evaluation
临床医生在只有50%的自然流产患者的妊娠产物中发现绒毛，另外有30%的绒毛被病理科医生发现。Chorionic villi in specimens from women with the diagnosis of spontaneous abortion were identified clinically in only half of cases and by the pathologist in another 30 percent.
因此,剩下的20%的患者仍然有异位妊娠的可能性(Lindahl, 1986)。Thus in 20 percent of women, an ectopic pregnancy was still a consideration (Lindahl, 1986).
诊断性腹腔镜仍然是诊断异位妊娠的金标准（图 7-9，彩图7-3)。Confirmation by diagnostic laparoscopy remains the gold standard for diagnosis of ectopic pregnancy (Fig. 7-9).