Gardner F J, Konje J C, Brown L, Khanna S, Bell S C, Taylor D J, al-Azzawi F
Gynaecology Research Group, Department of Obstetrics and Gynaecology, Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester LE2 7LX, UK.
Climacteric. 1998 Sep;1(3):180-7. doi: 10.3109/13697139809085539.
The aim of this study was to assess the ability of transvaginal sonography (TVS) and office hysteroscopy with sharp curettage to characterize the morphological changes in the uteri of asymptomatic postmenopausal women taking long-term tamoxifen for breast cancer. The overall acceptability of a single-visit screening clinic for these women was also evaluated. Fifty-eight women were recruited from patients undergoing regular follow-up at the Leicester Royal Infirmary for breast cancer. A single-visit clinic was acceptable to 94.8% of these women. Transvaginal sonography detected endometrial thickness of greater than 5 mm in 84.5% of cases, but there was no relationship between total tamoxifen exposure and endometrial thickness. Transvaginal sonography also detected uterine lesions such as fibroids and endometrial cysts in 34.5% of cases. Hysteroscopy detected the latter uterine lesions in 53.4% of cases, with three cases (5.2%) of endometrial polyps also being identified in these women. Sharp curettage sampling of the endometrium produced specimens sufficient for diagnosis in 84.5% of cases; 70.7% of specimens were reported as showing types of 'quiescent' endometrium with 13.8% of specimens showing 'active' endometrium. In the latter group, there was a case of complex hyperplasia detected and also a case with granulomatous endometritis. For each histopathological diagnosis identified, there was a wide range of endometrial thickness recorded by TVS. A single-visit screening clinic involving TVS and hysteroscopy with sharp curettage was acceptable to asymptomatic women taking tamoxifen. However, hysteroscopy was more effective than TVS in detecting endometrial lesions such as polyps, fibroids and cystic areas. Although TVS detected endometrial thickness greater than 5 mm in the majority of cases, there were no malignancies detected and, for each histopathological classification, there was a wide range of endometrial thickness associated. Thus, the isolated use of TVS is insufficient for screening the endometria of these women.
本研究的目的是评估经阴道超声检查（TVS）以及联合锐性刮宫的门诊宫腔镜检查对长期服用他莫昔芬治疗乳腺癌的无症状绝经后女性子宫形态学变化的特征描述能力。同时还评估了为这些女性设立的单次就诊筛查门诊的总体可接受性。从莱斯特皇家医院接受乳腺癌定期随访的患者中招募了58名女性。94.8%的女性接受单次就诊门诊。经阴道超声检查在84.5%的病例中检测到子宫内膜厚度大于5mm，但他莫昔芬总暴露量与子宫内膜厚度之间无相关性。经阴道超声检查还在34.5%的病例中检测到子宫肌瘤和子宫内膜囊肿等子宫病变。宫腔镜检查在53.4%的病例中检测到后者这些子宫病变，在这些女性中还发现了3例（5.2%）子宫内膜息肉。子宫内膜锐性刮宫取样在84.5%的病例中获得了足以用于诊断的标本；70.7%的标本报告显示为“静止期”子宫内膜类型，13.8%的标本显示为“活跃期”子宫内膜。在后一组中，检测到1例复杂性增生病例以及1例肉芽肿性子宫内膜炎病例。对于每种确定的组织病理学诊断，经阴道超声检查记录的子宫内膜厚度范围很广。对于服用他莫昔芬的无症状女性，涉及经阴道超声检查和联合锐性刮宫的宫腔镜检查的单次就诊筛查门诊是可接受的。然而，宫腔镜检查在检测息肉、肌瘤和囊性区域等子宫内膜病变方面比经阴道超声检查更有效。虽然经阴道超声检查在大多数病例中检测到子宫内膜厚度大于5mm，但未检测到恶性肿瘤，并且对于每种组织病理学分类，相关的子宫内膜厚度范围很广。因此，单独使用经阴道超声检查不足以筛查这些女性的子宫内膜。
