Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02116, USA.
Menopause. 2011 Apr;18(4):421-4. doi: 10.1097/gme.0b013e3181fedfc0.
The major role of ultrasound in the evaluation of abnormal uterine bleeding, other than that occurring during pregnancy, is in postmenopausal women. Because postmenopausal bleeding can be the presenting symptom of endometrial cancer, any woman with this symptom should be evaluated to diagnose or exclude carcinoma. Over the last two decades, the role of ultrasound in the evaluation of postmenopausal bleeding has changed markedly, from little or no role in 1990 to a major role today. In the intervening years, numerous studies have shown that ultrasound is at least as sensitive as endometrial biopsy for endometrial cancer and that ultrasound can reliably exclude cancer without the need for biopsy in some women with postmenopausal bleeding. In particular, numerous studies have shown that women with an endometrial thickness of 4 mm or less have an extremely low likelihood of endometrial cancer and thus do not need to undergo endometrial biopsy. Ultrasound can also help in the selection of an appropriate biopsy technique. In a woman with postmenopausal bleeding and a thick endometrium, a sonohysterogram can determine whether the endometrium is diffusely thick or has focal areas of thickening. With diffuse thickening, a blind endometrial biopsy is appropriate. When there are one or more focal areas of thickening, hysteroscopic biopsy is likely to be the better choice. We present two clinical algorithms, either of which is an acceptable approach to the use of ultrasound and/or endometrial biopsy in women with postmenopausal bleeding: the "ultrasound-first" approach and the "biopsy-first" approach.
超声在评估异常子宫出血（除妊娠期间出血外）中的主要作用在于绝经后妇女。由于绝经后出血可能是子宫内膜癌的首发症状，因此任何出现这种症状的妇女都应进行评估以诊断或排除癌症。在过去的二十年中，超声在绝经后出血评估中的作用发生了显著变化，从 1990 年几乎没有作用到今天的主要作用。在此期间，许多研究表明，超声在诊断子宫内膜癌方面与子宫内膜活检一样敏感，并且在一些绝经后出血的妇女中，超声可以可靠地排除癌症而无需进行活检。特别是，许多研究表明，子宫内膜厚度为 4 毫米或更薄的妇女患子宫内膜癌的可能性极低，因此不需要进行子宫内膜活检。超声还可以帮助选择适当的活检技术。对于绝经后出血且子宫内膜增厚的妇女，超声子宫造影可以确定子宫内膜是弥漫性增厚还是有局灶性增厚区域。弥漫性增厚时，盲目子宫内膜活检是合适的。当存在一个或多个局灶性增厚区域时，宫腔镜活检可能是更好的选择。我们提出了两种临床算法，这两种算法都可以接受在绝经后出血妇女中使用超声和/或子宫内膜活检：“超声优先”方法和“活检优先”方法。
