Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
Maturitas. 2011 Feb;68(2):155-64. doi: 10.1016/j.maturitas.2010.11.010. Epub 2010 Dec 8.
Postmenopausal bleeding (PMB) is a common complaint in general gynecological practice. Women with PMB have around a 10% chance of having endometrial carcinoma and therefore PMB always needs further evaluation. This article summarizes the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of 3mm is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of test.
绝经后出血（PMB）是妇科常见的主诉。PMB 的女性约有 10%的机会患有子宫内膜癌，因此 PMB 始终需要进一步评估。本文总结了该主题的综述，并概述了 PMB 患者诊断工具的使用。描述了四种类型的诊断测试：超声测量子宫内膜厚度、子宫内膜取样、宫腔镜检查和盐水灌注超声检查。所有四种方法都已被证明可以独立准确地排除子宫内膜癌。然而，在系统评价和国际指南中，对于在 PMB 女性中应如何使用这些方法的顺序，并没有达成共识。对于有症状的女性，建议使用 3mm 的子宫内膜厚度截断值，但这种策略的成本效益尚未得到证实。现在的研究应该集中在将个体患者特征和癌症的术前概率纳入 PMB 调查的算法中，并对四种测试类型进行最具成本效益的序列组合。
