Epstein E, Skoog L, Valentin L
Department of Obstetrics and Gynecology, University Hospital MAS, University of Lund, Malmö, Sweden.
Acta Obstet Gynecol Scand. 2001 Oct;80(10):959-64. doi: 10.1034/j.1600-0412.2001.801015.x.
MAIN QUESTION: To compare the diagnostic properties of Endorette and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women's experiences of the two methods.
In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling.
Endorette sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette sampling, and the doctor underestimated the pain in 62% of the women. Endorette failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette device had not reached the uterine fundus. In women with endometrium < 7 mm, Endorette and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium > or =7 mm, Endorette yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C.
Endorette and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium < 7 mm. D&C is superior to Endorette in women with endometrium > or =7 mm.
主要问题：比较Endorette采样器与诊断性刮宫术（D&C）对绝经后出血女性的诊断特性，将这些特性与超声测量的子宫内膜厚度相关联，并评估女性对这两种方法的体验。
在一项前瞻性研究中，对133例连续的绝经后出血女性进行经阴道超声检查。测量子宫内膜厚度后，在无麻醉情况下进行Endorette采样。诊断性刮宫术在六周内于全身麻醉下进行。每次采样程序完成后，女性填写一份关于她们采样体验的问卷。
16%（2l/133）的女性Endorette采样失败。超过一半（56%）的女性在Endorette采样期间经历中度或强烈疼痛，且医生低估了62%女性的疼痛程度。Endorette未能诊断出诊断性刮宫术中发现的7例子宫内膜癌中的2例（29%）。在这两例中的一例中，检查者怀疑Endorette采样器未到达子宫底部。对于子宫内膜<7mm的女性，Endorette采样器与诊断性刮宫术在获取足够的子宫内膜样本以及区分正常子宫内膜、良性病理性子宫内膜和恶性病变方面显示出相似的结果。对于子宫内膜≥7mm的女性，Endorette采样器获取不足样本的频率显著高于诊断性刮宫术（23%对6%，p=0.02；McNemar检验），并且遗漏了所有息肉以及诊断性刮宫术诊断出的大多数（77%）增生病变。
对于绝经后出血且子宫内膜<7mm的女性，Endorette采样器与诊断性刮宫术具有相似的诊断特性。对于子宫内膜≥7mm的女性，诊断性刮宫术优于Endorette采样器。
