Costa Hélio de Lima Ferreira Fernandes, Costa Laura Olinda Bregieiro Fernandes
Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, PE, Brasil.
Rev Bras Ginecol Obstet. 2008 Oct;30(10):524-30. doi: 10.1590/s0100-72032008001000008.
Detection of endometrial cancer in asymptomatic women has not proved to be a cost-effective procedure. Studies on this matter have shown that ultrasonography as a detecting method presents a high ratio of false-positive results and a negligible effect on the mortality rate. This way, the assistance strategy should be based on earlier diagnosis and appropriate treatment in women who present postmenopause bleeding. Being a non-invasive method, largely available and with high sensitivity, the transvaginal ultrasonography should be the initial investigative method. Though there is no consensus about the echographical endometrial thickness, above which the investigation is to proceed, diagnostic hysteroscopy should be the next step. The risk of neoplasia in endometriums with thickness under or equal to 3 mm is low enough to limit hysteroscopy to exceptional cases. Biopsy must be a necessary part of the hysteroscopy, because the diagnosis, made on visual basis, alone may lead to false results. Outpatient hysteroscopy can be done in more than 95% of the cases, even in menopausal women, rarely with severe complications. The adoption of "non-contact" examination techniques and the progressive reduction of the hysteroscope diameter have decreased the discomfort associated to small outpatient procedures.
在无症状女性中检测子宫内膜癌尚未被证明是一种具有成本效益的方法。关于此事的研究表明，超声检查作为一种检测方法呈现出较高的假阳性率，且对死亡率的影响微乎其微。因此，辅助策略应基于对出现绝经后出血的女性进行早期诊断和适当治疗。经阴道超声检查作为一种非侵入性方法，广泛可用且具有高灵敏度，应作为初始检查方法。尽管对于进行进一步检查的超声子宫内膜厚度尚无共识，但诊断性宫腔镜检查应是下一步。子宫内膜厚度小于或等于3mm时发生肿瘤的风险足够低，足以将宫腔镜检查限制在特殊情况下。活检必须是宫腔镜检查的必要组成部分，因为仅基于视觉做出的诊断可能会导致错误结果。超过95%的病例甚至在绝经后女性中都可以进行门诊宫腔镜检查，很少出现严重并发症。“非接触式”检查技术的采用以及宫腔镜直径的逐渐减小，减少了与小型门诊手术相关的不适。
