Spicer J M, Siebert I, Kruger T F
Department of Obstetrics and Gynaecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa.
Gynecol Obstet Invest. 2006;61(3):174-8. doi: 10.1159/000091413. Epub 2006 Feb 9.
To assess the optimal diagnostic approach to women with postmenopausal bleeding by comparing transvaginal ultrasound and endometrial sampling with office hysteroscopy.
A prospective collective study was performed on 102 consecutive patients with postmenopausal bleeding who were evaluated by ultrasound measurement of the endometrial thickness (EL), endometrial sampling by Accurette and outpatient hysteroscopy and directed biopsy.
Accurette was inadequate for histological diagnosis in 65 of 136 samples and many repeat investigations were required. In all 16 cases of endometrial polyps, ultrasound measurement of the EL was > or =4 mm and hysteroscopy confirmed the findings. Accurette detected only 5 polyps. All 7 cases of endometrial hyperplasia were detected using an EL of > or =4 mm and hysteroscopy confirmed the findings. Accurette failed to detect 5 out of 7 cases of endometrial hyperplasia. Five cases of endometrial cancer were diagnosed: all had an EL > or =4 mm but were inadequately sampled for diagnostic purposes in 3 cases. A definitive diagnosis was made on hysteroscopy in 4 cases (1 patient did not have a hysteroscopy).
Accurette is not a good sampling device for the diagnosis of postmenopausal bleeding. An ultrasound measurement of the EL > or =4 mm in patients with postmenopausal bleeding warrants further investigation. Outpatient office hysteroscopy is an accurate and sensitive modality to employ as a first line investigation for definitive diagnosis.
通过比较经阴道超声、子宫内膜取样与门诊宫腔镜检查，评估绝经后出血女性的最佳诊断方法。
对102例连续的绝经后出血患者进行前瞻性研究，这些患者接受了子宫内膜厚度（EL）的超声测量、Accurette子宫内膜取样、门诊宫腔镜检查及定向活检。
在136份样本中，有65份Accurette取样不适合组织学诊断，需要多次重复检查。在所有16例子宫内膜息肉病例中，超声测量EL≥4mm，宫腔镜检查证实了这一结果。Accurette仅检测出5例息肉。所有7例子宫内膜增生病例均通过EL≥4mm检测出，宫腔镜检查证实了这一结果。Accurette未能检测出7例子宫内膜增生病例中的5例。诊断出5例子宫内膜癌：所有病例EL均≥4mm，但3例因取样不足无法用于诊断目的。4例通过宫腔镜检查做出明确诊断（1例患者未进行宫腔镜检查）。
Accurette不是诊断绝经后出血的良好取样设备。绝经后出血患者超声测量EL≥4mm值得进一步研究。门诊宫腔镜检查是一种准确且敏感的一线诊断检查方法。
