Bourne T H, Campbell S, Steer C V, Royston P, Whitehead M I, Collins W P
Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, Denmark Hill, London, United Kingdom.
Gynecol Oncol. 1991 Mar;40(3):253-9. doi: 10.1016/0090-8258(90)90287-u.
A prospective study was undertaken to assess whether changes in uterine blood flow could be used to detect endometrial cancer in 138 selected postmenopausal women (34 had uterine bleeding, 17 with endometrial cancer; 104 did not have uterine bleeding; 1 had endometrial cancer). Thirty-five of the asymptomatic women were receiving estrogen replacement therapy (ERT). The endpoints were endometrial (including tumoral) thickness and a pulsatility index (PI) derived from flow velocity waveforms recorded from both uterine arteries and from within a tumor. We found an overlap in endometrial thickness between those women with endometrial cancer and those without. The mean arterial PI value was invariably lower in women with postmenopausal bleeding and endometrial cancer (mean 0.91, range 0.31-1.49) than in those with other reasons for the blood loss (mean 3.83, range 1.95-6.40). The index was 1.10 in the woman with endometrial cancer but no sign of postmenopausal bleeding. Blood flow impedance was inversely related to stage of cancer. PI values in healthy women tended to increase slightly with age, but decrease during ERT. The detection rate was 100% within the limitations of the study design, and the false-positive rate was 1% for all women not receiving ERT and 11% for patients receiving ERT. Malignant tumors show signs of altered vascularization and a low PI (mean 0.49, range 0.29-0.92). We conclude that transvaginal ultrasonography, with or without color flow imaging, and blood flow analysis can be used to detect endometrial cancer in women with postmenopausal bleeding. A screening procedure for asymptomatic women must allow for changes in uterine blood flow during ERT.
一项前瞻性研究旨在评估子宫血流变化是否可用于检测138名选定的绝经后妇女的子宫内膜癌（34名有子宫出血，其中17名患有子宫内膜癌；104名没有子宫出血；1名患有子宫内膜癌）。35名无症状妇女正在接受雌激素替代疗法（ERT）。研究终点为子宫内膜（包括肿瘤）厚度以及从双侧子宫动脉和肿瘤内部记录的血流速度波形得出的搏动指数（PI）。我们发现患有子宫内膜癌的妇女和未患子宫内膜癌的妇女在子宫内膜厚度上存在重叠。绝经后出血并患有子宫内膜癌的妇女的平均动脉PI值（平均0.91，范围0.31 - 1.49）始终低于因其他原因失血的妇女（平均3.83，范围1.95 - 6.40）。患有子宫内膜癌但无绝经后出血迹象的妇女的该指数为1.10。血流阻抗与癌症分期呈负相关。健康女性的PI值往往随年龄略有增加，但在ERT期间会降低。在研究设计的局限性范围内，检测率为100%，未接受ERT的所有妇女的假阳性率为1%，接受ERT的患者的假阳性率为11%。恶性肿瘤显示出血管形成改变的迹象且PI值较低（平均0.49，范围0.29 - 0.92）。我们得出结论，经阴道超声检查，无论有无彩色血流成像，以及血流分析均可用于检测绝经后出血妇女的子宫内膜癌。无症状妇女的筛查程序必须考虑到ERT期间子宫血流的变化。
