Salman Mehmet C, Bozdag Gurkan, Dogan Selen, Yuce Kunter
Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Aust N Z J Obstet Gynaecol. 2013 Oct;53(5):484-8. doi: 10.1111/ajo.12113. Epub 2013 Aug 2.
Women with postmenopausal bleeding should be evaluated efficiently to exclude endometrial carcinoma.
To estimate the risk of endometrial cancer using individual case characteristics among women with postmenopausal bleeding in whom the endometrial thickness is >4 mm.
Women with postmenopausal bleeding underwent clinical evaluation followed by transvaginal ultrasonography and endometrial biopsy. Clinical evaluation included age, body mass index, duration of menopause, number of bleeding episodes and amount of bleeding.
This study included 142 women, and endometrial carcinoma was found in 18 (12.7%). Older age, higher body mass index, longer duration of menopause, longer lasting bleeding episodes, higher amount of bleeding and recurrent bleeding episodes were the clinical characteristics associated with endometrial cancer. However, multivariate analysis revealed >55 years of age during postmenopausal bleeding, history of recurrent bleeding episodes and bleeding exceeding 5 pads per day in each episode as significant parameters, which predicted the presence of endometrial cancer among women with postmenopausal bleeding.
Prompt evaluation is required in women with postmenopausal bleeding to exclude endometrial cancer. Transvaginal ultrasonography is a reasonable first-line approach, and invasive sampling is required when ultrasonographic endometrial thickness is above 4 mm. However, about 90% of women with postmenopausal bleeding will finally be found to have a nonmalignant condition. Therefore, women who are at increased cancer risk should further be distinguished. This may be achieved using individual patient characteristics that result in a more accurate evaluation strategy with lower rates of unnecessary invasive procedures.
绝经后出血的女性应接受有效评估以排除子宫内膜癌。
利用绝经后出血且子宫内膜厚度>4mm的女性个体病例特征评估子宫内膜癌风险。
绝经后出血的女性接受临床评估，随后进行经阴道超声检查和子宫内膜活检。临床评估包括年龄、体重指数、绝经持续时间、出血次数和出血量。
本研究纳入142名女性，其中18名（12.7%）发现患有子宫内膜癌。年龄较大、体重指数较高、绝经持续时间较长、出血持续时间较长、出血量较多和反复出血是与子宫内膜癌相关的临床特征。然而，多因素分析显示绝经后出血时年龄>55岁、反复出血史以及每次出血超过5片卫生巾为显著参数，这些参数可预测绝经后出血女性中子宫内膜癌的存在。
绝经后出血的女性需要及时评估以排除子宫内膜癌。经阴道超声检查是合理的一线检查方法，当超声检查显示子宫内膜厚度超过4mm时需要进行有创取样。然而，约90%的绝经后出血女性最终会被发现患有非恶性疾病。因此，应进一步区分癌症风险增加的女性。这可以通过个体患者特征来实现，从而形成一种更准确的评估策略，减少不必要的有创检查率。
