Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D
Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
KU Leuven Department of Development and Regeneration, Leuven, Belgium.
Facts Views Vis Obgyn. 2015;7(1):17-24.
Our primary aim was to assess how patients' characteristics, bleeding pattern, sonographic endometrial thickness (ET) and additional features at unenhanced ultrasound examination (UTVS) and at fluid instillation sonography (FIS) contribute to the diagnosis of intracavitary uterine pathology in women presenting with abnormal uterine bleeding (AUB). We further aimed to report the prevalence of pathology in women presenting with AUB.
1220 consecutive women presenting with AUB underwent UTVS, colour Doppler imaging (CDI) and FIS. Most women (n = 1042) had histological diagnosis.
Mean age was 50 years and 37% were postmenopausal. Of 1220 women 54% were normal, polyps were diagnosed in 26%, intracavitary fibroids in 11%, hyperplasia without atypia in 4% and cancer in 3%. All cancers were diagnosed in postmenopausal (7%) or perimenopausal (1%) women. ET had a low predictive value in premenopausal women (LR+ and LR- of 1.34 and 0.74, respectively), while FIS had a LR+ and LR- of 6.20 and 0.24, respectively. After menopause, ET outperformed all patient characteristics for the prediction of endometrial pathology (LR+ and LR- of 3.13 and 0.24). The corresponding LR+ and LR- were 10.85 and 0.71 for CDI and 8.23 and 0.26 for FIS.
About half of the women presenting to a bleeding clinic will have pathology. In premenopausal women, benign lesions are often the cause of AUB. For the prediction of intracavitary pathology ET is of little value in premenopausal women. CDI and FIS substantially improve the diagnostic accuracy.
我们的主要目的是评估患者特征、出血模式、超声检查时的子宫内膜厚度（ET）以及未增强超声检查（UTVS）和液体灌注超声检查（FIS）时的其他特征如何有助于诊断出现异常子宫出血（AUB）的女性的宫腔内子宫病变。我们还旨在报告出现AUB的女性中病变的患病率。
1220例连续出现AUB的女性接受了UTVS、彩色多普勒成像（CDI）和FIS检查。大多数女性（n = 1042）有组织学诊断。
平均年龄为50岁，37%为绝经后女性。在1220名女性中，54%正常，26%诊断为息肉，11%诊断为宫腔内肌瘤，4%诊断为无异型增生，3%诊断为癌症。所有癌症均在绝经后（7%）或围绝经期（1%）女性中诊断出。ET在绝经前女性中的预测价值较低（阳性似然比和阴性似然比分别为1.34和0.74），而FIS的阳性似然比和阴性似然比分别为6.20和0.24。绝经后，ET在预测子宫内膜病变方面优于所有患者特征（阳性似然比和阴性似然比分别为3.13和0.24）。CDI的相应阳性似然比和阴性似然比分别为10.85和0.71，FIS的相应阳性似然比和阴性似然比分别为8.23和0.26。
到出血诊所就诊的女性中约一半会有病变。在绝经前女性中，良性病变通常是AUB的原因。对于预测宫腔内病变，ET在绝经前女性中价值不大。CDI和FIS显著提高了诊断准确性。
