Turnbull Hilary L, Akrivos Nikolaos, Simpson Paul, Duncan Timothy J, Nieto Joaquin J, Burbos Nikolaos
Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
Arch Gynecol Obstet. 2017 Feb;295(2):445-450. doi: 10.1007/s00404-016-4249-9. Epub 2016 Dec 1.
This aim of this study is to determine the risk of endometrial cancer in symptomatic postmenopausal women, when endometrial thickness on transvaginal ultrasonography is equal to or greater than 10 mm, and subsequent office-based endometrial sampling histology is negative.
This is a prospective cross-sectional study, performed in a gynaecological oncology centre in the United Kingdom between February 2008 and July 2012. All postmenopausal women presenting with vaginal bleeding were investigated using transvaginal ultrasonography. Women with endometrial thickness measurements equal to or greater than 10 mm and negative office-based endometrial biopsy underwent hysteroscopy and endometrial biopsies.
Over a 52-month period, 4148 women were investigated for postmenopausal vaginal bleeding. 588 (14.2%) women were found to have endometrial thickness measurements of equal to or greater than 10 mm on transvaginal ultrasonography. 170 (28.9%) cases of endometrial cancer were diagnosed in this group: 149 (87.6%) of the cancer cases were diagnosed in the outpatient setting with a Pipelle endometrial sampler, whilst 21 (12.4%) had a negative Pipelle sample and were diagnosed with hysteroscopy. The group diagnosed with hysteroscopy had lower BMI (32.7 kg/m versus 39.7 kg/m, p < 0.001) whilst the group diagnosed with Pipelle was more likely to have a history of hypertension and diabetes mellitus (p = 0.019 for both). The sensitivity of Pipelle was 87.65%.
For women presenting with postmenopausal bleeding and where the endometrial thickness is equal to or greater than 10 mm and Pipelle sampling is negative, hysteroscopic evaluation with directed biopsy is strongly recommended.
本研究旨在确定有症状的绝经后女性经阴道超声检查显示子宫内膜厚度等于或大于10mm且随后门诊子宫内膜取样组织学检查结果为阴性时患子宫内膜癌的风险。
这是一项前瞻性横断面研究，于2008年2月至2012年7月在英国一家妇科肿瘤中心进行。所有出现阴道出血的绝经后女性均接受经阴道超声检查。子宫内膜厚度测量值等于或大于10mm且门诊子宫内膜活检结果为阴性的女性接受了宫腔镜检查及子宫内膜活检。
在52个月的时间里，对4148名绝经后阴道出血的女性进行了调查。经阴道超声检查发现588名（14.2%）女性的子宫内膜厚度等于或大于10mm。该组诊断出170例（28.9%）子宫内膜癌：其中癌症病例的149例（87.6%）在门诊使用Pipelle子宫内膜取样器诊断出来，而21例（12.4%）Pipelle取样结果为阴性，通过宫腔镜检查诊断出来。经宫腔镜检查诊断的组BMI较低（分别为32.7kg/m²和39.7kg/m²，p<0.001），而经Pipelle取样诊断的组更有可能有高血压和糖尿病病史（两者p均为0.019）。Pipelle的敏感性为87.65%。
对于出现绝经后出血且子宫内膜厚度等于或大于10mm且Pipelle取样结果为阴性的女性，强烈建议进行宫腔镜引导下活检评估。
