Seckin Berna, Cicek Mahmut Nedim, Dikmen Asiye Ugras, Bostancı Esra Isci, Muftuoglu Kamil Hakan
Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
Department of Public Health, Gazi University, Ankara, Turkey.
J Clin Ultrasound. 2016 Jul 8;44(6):339-46. doi: 10.1002/jcu.22329. Epub 2016 Feb 9.
To investigate the diagnostic value of endometrial thickness measurement on sonography in predicting endometrial pathologies in postmenopausal women with vaginal bleeding and in those with asymptomatic thickened endometrium.
Six hundred two postmenopausal women with vaginal bleeding or asymptomatic thickened endometrium were evaluated in this study. Two hundred seventy-four women with postmenopausal bleeding regardless of endometrial thickness (group 1: symptomatic) and 328 women with an incidental finding of thickened endometrium (≥5 mm) without bleeding (group 2: asymptomatic) underwent endometrial biopsy for histopathologic examination. The receiver operating characteristics curves of endometrial thickness measurement for prediction of endometrial pathologies were analyzed.
Endometrial carcinoma was detected in eight women (2.9%) in group 1 and in three (0.9%) in group 2. The best cutoff point for endometrial thickness in predicting endometrial carcinoma in group 1 was 8.2 mm, which provided 75% sensitivity (95% confidence interval [CI], 40.9-92.9%) and 74% specificity (95% CI, 68-78.5%); area under the receiver operating characteristics curve (AUC), 0.88; 95% CI, 0.76-1.00%; p = 0.0001. In group 2, the AUC was 0.76 (95% CI, 0.46-1.00; p = 0.114); the evidence was inconclusive as to the relationship between endometrial thickness and malignancy. For the prediction of polyps, the AUCs of endometrial thickness were 0.77 for group 1 (95% CI, 0.71-0.83%; p = 0.0001) and 0.61 for group 2 (95% CI, 0.54-0.67%; p = 0.002).
Sonographically determined endometrial thickness measurement shows high diagnostic performance for detection of endometrial cancer in symptomatic postmenopausal women at the optimal cutoff thickness of approximately 8 mm, although the evidence supporting the use of sonography for predicting malignancy in asymptomatic women is inconclusive. For polyp detection, this technique shows moderate diagnostic ability in symptomatic women, but its predictive value is low in asymptomatic women. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:339-346, 2016.
探讨超声测量子宫内膜厚度对绝经后阴道出血妇女及无症状子宫内膜增厚妇女子宫内膜病变的诊断价值。
本研究评估了602例绝经后阴道出血或无症状子宫内膜增厚的妇女。274例绝经后出血妇女，无论子宫内膜厚度如何（第1组：有症状），以及328例偶然发现子宫内膜增厚（≥5mm）且无出血的妇女（第2组：无症状）均接受了子宫内膜活检以进行组织病理学检查。分析了子宫内膜厚度测量预测子宫内膜病变的受试者操作特征曲线。
第1组中有8名妇女（2.9%）检测出子宫内膜癌，第2组中有3名（0.9%）。第1组中，预测子宫内膜癌的子宫内膜厚度最佳截断点为8.2mm，其灵敏度为75%（95%置信区间[CI]，40.9 - 92.9%），特异度为74%（95%CI，68 - 78.5%）；受试者操作特征曲线下面积（AUC）为0.88；95%CI，0.76 - 1.00%；p = 0.0001。在第2组中，AUC为0.76（95%CI，0.46 - 1.00；p = 0.114）；关于子宫内膜厚度与恶性肿瘤之间的关系，证据尚无定论。对于息肉的预测，第1组中子宫内膜厚度的AUC为0.77（95%CI，0.71 - 0.83%；p = 0.0001），第2组中为0.61（95%CI，0.54 - 0.67%；p = 0.002）。
超声测量子宫内膜厚度对于有症状的绝经后妇女，在最佳截断厚度约为8mm时，对子宫内膜癌的检测具有较高的诊断性能，尽管支持超声用于预测无症状妇女恶性肿瘤的证据尚无定论。对于息肉检测，该技术在有症状妇女中显示出中等诊断能力，但在无症状妇女中其预测价值较低。©2016威利期刊公司。《临床超声杂志》2016年第44卷：339 - 346页。
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