Visser Nicole C M, Sparidaens Ellen M, van den Brink Jan-Willem, Breijer Maria C, Boss Erik A, Veersema Sebastiaan, Siebers Albert G, Bulten Johan, Pijnenborg Johanna M A, Bekkers Ruud L M
Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
Acta Obstet Gynecol Scand. 2016 Dec;95(12):1418-1424. doi: 10.1111/aogs.13022. Epub 2016 Oct 14.
Women with postmenopausal bleeding and endometrial thickness >4 mm undergo endometrial sampling to exclude endometrial cancer. The aim of this study is to investigate the relative risk of developing endometrial cancer in a prospective cohort after initial work-up for postmenopausal bleeding showing reassuring histology or insufficient sampling.
All women presenting with postmenopausal bleeding were prospectively included from January 2009 to April 2011. Follow-up data were collected from patient charts and PALGA (Dutch Pathology Registry). Hazard ratios for endometrial cancer were determined by calculating standardized incidence ratios.
A total of 668 women were included and 568 women were available for follow-up [median follow-up time 47 (range 7-63) months]. Women who presented with postmenopausal bleeding, endometrial thickness >4 mm and hyperplasia without atypia on biopsy at the first presentation showed a significantly increased risk (standardized incidence ratio 17.15, 95% confidence interval 1.96-61.93) of being diagnosed with endometrial cancer during the first four years of follow up compared with the age-specific population. All women that developed endometrial cancer after initial reassuring histology presented with recurrent postmenopausal bleeding. None of the women with endometrial thickness >4 mm and no or insufficient sample for histology at the first presentation developed endometrial cancer during the follow up.
Although in general, women with endometrial hyperplasia without atypia are considered to have a low risk for cancer, we observed a significant long-term risk of endometrial cancer after postmenopausal bleeding. Whether additional diagnostics or a more stringent follow-up regimen would be cost-effective, needs to be studied.
绝经后出血且子宫内膜厚度>4mm的女性需进行子宫内膜取样以排除子宫内膜癌。本研究的目的是调查在绝经后出血的初始检查显示组织学结果令人放心或取样不足的前瞻性队列中发生子宫内膜癌的相对风险。
2009年1月至2011年4月前瞻性纳入所有出现绝经后出血的女性。随访数据从患者病历和PALGA（荷兰病理登记处）收集。通过计算标准化发病率比来确定子宫内膜癌的风险比。
共纳入668名女性，568名女性可供随访[中位随访时间47（范围7 - 63）个月]。首次就诊时出现绝经后出血、子宫内膜厚度>4mm且活检显示无异型增生的女性，与特定年龄人群相比，在随访的前四年中被诊断为子宫内膜癌的风险显著增加（标准化发病率比17.15，95%置信区间1.96 - 61.93）。所有在初始组织学结果令人放心后发生子宫内膜癌的女性均出现复发性绝经后出血。首次就诊时子宫内膜厚度>4mm且组织学样本无或不足的女性在随访期间均未发生子宫内膜癌。
虽然一般来说，无异型增生的子宫内膜增生女性被认为患癌风险较低，但我们观察到绝经后出血后存在显著的子宫内膜癌长期风险。额外的诊断或更严格的随访方案是否具有成本效益，有待研究。
