Fong K, Kung R, Lytwyn A, Trudeau M, Chapman W, Nugent P, Glanc P, Manchul L, Szabunio D, Myhr T
Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville St, Toronto, Ontario, Canada M5S 1B2.
Radiology. 2001 Sep;220(3):765-73. doi: 10.1148/radiol.2203010011.
To determine performance characteristics of transvaginal ultrasonography (US) and hysterosonography for diagnosing endometrial abnormality in asymptomatic postmenopausal women with breast cancer receiving tamoxifen.
The authors prospectively examined 138 women receiving tamoxifen by using transvaginal US, hysterosonography, and office hysteroscopy. The combined hysteroscopic-histopathologic diagnosis was the reference standard. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of transvaginal US and hysterosonography were calculated.
All 138 women underwent transvaginal US; 104, successful hysterosonography; and 117, successful hysteroscopy. Uterine abnormality was present in 47 (40.2%) of 117 women: 45 with polyps and two with submucosal fibroids. Receiver operating characteristic curve analysis revealed 6 mm to be the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities. When a thickness greater than 6 mm or a focal endometrial finding was considered abnormal, transvaginal US had a sensitivity of 85.1% and a specificity of 55.7%. In 92 women who completed transvaginal US, hysterosonography, and hysteroscopy, hysterosonography was more specific (79.2%; P =.008) but not significantly more sensitive (89.7%; P =.508) than transvaginal US. When women with abnormal transvaginal US findings were further examined with hysterosonography, the sequential combination of transvaginal US and hysterosonography was more specific (77.1%) than transvaginal US alone (P <.001), without a significant decrease in sensitivity (78.7%; P =.25).
In asymptomatic postmenopausal women receiving tamoxifen, 6 mm is the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities with transvaginal US. Further examination with hysterosonography can improve specificity by reducing the high false-positive rate of transvaginal US.
确定经阴道超声检查（US）和子宫超声造影对诊断接受他莫昔芬治疗的无症状绝经后乳腺癌妇女子宫内膜异常的性能特征。
作者前瞻性地对138名接受他莫昔芬治疗的妇女进行经阴道超声、子宫超声造影及门诊宫腔镜检查。宫腔镜-组织病理学联合诊断为参考标准。计算经阴道超声和子宫超声造影的敏感性、特异性、阳性和阴性预测值以及似然比。
138名妇女均接受经阴道超声检查；104名成功接受子宫超声造影；117名成功接受宫腔镜检查。117名妇女中有47名（40.2%）存在子宫异常：45名有息肉，2名有黏膜下肌瘤。受试者操作特征曲线分析显示，诊断子宫内膜异常的最佳子宫内膜厚度临界值为6mm。当内膜厚度大于6mm或内膜局灶性表现被视为异常时，经阴道超声的敏感性为85.1%，特异性为55.7%。在92名完成经阴道超声、子宫超声造影和宫腔镜检查的妇女中，子宫超声造影的特异性更高（79.2%；P = 0.008），但敏感性并不显著高于经阴道超声（89.7%；P = 0.508）。当经阴道超声检查结果异常的妇女进一步接受子宫超声造影检查时，经阴道超声和子宫超声造影的序贯联合比单独经阴道超声更具特异性（77.1%）（P < 0.001），且敏感性无显著降低（78.7%；P = 0.25）。
在接受他莫昔芬治疗的无症状绝经后妇女中，6mm是经阴道超声诊断子宫内膜异常的最佳子宫内膜厚度临界值。进一步进行子宫超声造影检查可通过降低经阴道超声的高假阳性率来提高特异性。
