Famuyide Abimbola O, Shazly Sherif A M, Makdisi Peter B, El-Nashar Sherif A, Breitkopf Daniel M, Hopkins Matthew R, Laughlin-Tommaso Shannon K
1 Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, Minnesota.
2 Department of Obstetrics and Gynecology, Assiut University , Asyut, Egypt .
J Womens Health (Larchmt). 2016 Sep;25(9):889-96. doi: 10.1089/jwh.2015.5644. Epub 2016 Apr 11.
There is evidence that premenopausal hormones may persist for variable time after menopause. Histological specimens from postmenopausal women support the presence of follicular growth at that age. Residual ovarian function may explain postmenopausal bleeding (PMB), which is not associated with endometrial pathology. Our objective was to evaluate the effect of sonographic diagnosis of simple ovarian cysts on the association between thickened endometrium and endometrial pathology in women with PMB.
Data were retrospectively collected from medical records of women who underwent office hysteroscopy for PMB between January 2007 and October 2011. Women with sonographic reports within 3 months of presentation were included. Endometrial thickness and the presence of a simple ovarian cyst (≤5 cm) were documented by reviewing sonographic reports. Diagnosis of endometrial pathology was abstracted according to pathology reports or hysteroscopic impression. Endometria with hyperplasia, cancer, or polyps were considered pathological.
Of 836 women with PMB, 356 had recent transvaginal sonography and were included in the analysis. Pathological endometrium was documented in 129 (36.2%) women, including 29 (8.2%) with endometrial cancer. In women with PMB and no evidence of a simple ovarian cyst, endometrial thickness was an independent predictor of endometrial pathology and endometrial cancer with adjusted OR = 1.13 (95% CI = 1.07-1.19) and 1.16 (95% CI = 1.07-1.25), respectively. In the presence of simple ovarian cysts, the adjusted ORs for endometrial thickness as a predictor of endometrial pathology were 1.06 (95% CI = 0.90-1.25) and 0.84 (95% CI = 0.62-1.14), respectively.
The presence of simple ovarian cysts (≤5 cm) tempers the value of endometrial thickness in predicting endometrial pathology in women with PMB.
有证据表明绝经前激素在绝经后可能会持续存在不同时间。绝经后女性的组织学标本支持该年龄段存在卵泡生长。残余卵巢功能可能解释绝经后出血（PMB），而这与子宫内膜病变无关。我们的目的是评估单纯性卵巢囊肿的超声诊断对PMB女性子宫内膜增厚与子宫内膜病变之间关联的影响。
回顾性收集2007年1月至2011年10月因PMB接受门诊宫腔镜检查的女性的病历资料。纳入就诊3个月内有超声检查报告的女性。通过查阅超声检查报告记录子宫内膜厚度及是否存在单纯性卵巢囊肿（≤5厘米）。根据病理报告或宫腔镜检查印象提取子宫内膜病变的诊断结果。子宫内膜增生、癌症或息肉被视为病理性病变。
836例PMB女性中，356例近期接受了经阴道超声检查并纳入分析。129例（36.2%）女性记录有病理性子宫内膜，其中29例（8.2%）患有子宫内膜癌。在无单纯性卵巢囊肿证据的PMB女性中，子宫内膜厚度是子宫内膜病变和子宫内膜癌的独立预测因素，校正后的比值比（OR）分别为1.13（95%可信区间[CI]=1.07-1.19）和1.16（95%CI=1.07-1.25）。在存在单纯性卵巢囊肿的情况下，子宫内膜厚度作为子宫内膜病变预测因素的校正后OR分别为1.06（95%CI=0.90-1.25）和0.84（95%CI=0.62-1.14）。
存在单纯性卵巢囊肿（≤5厘米）会削弱子宫内膜厚度在预测PMB女性子宫内膜病变中的价值。
