Abdaal A, Mushtaq Y, Khasati L, Moneim J, Khan F, Ahmed H, Bolton H
1 School of Clinical Medicine, Ringgold Standard Institution, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
2 Department of Gynaecological Oncology, Ringgold Standard Institution, Addenbrooke's Hospital, Cambridge, UK.
Post Reprod Health. 2018 Jun;24(2):72-78. doi: 10.1177/2053369118755190. Epub 2018 Feb 5.
Objective To evaluate the role of transvaginal ultrasound triage in women with a history of tamoxifen treatment who present with post-menopausal bleeding. Study design A retrospective review was undertaken of patients who presented with symptoms of post-menopausal bleeding and underwent ultrasound triage. Endometrial thickness and ultrasonographic features were then correlated with hysteroscopic and histopathological outcome data. The findings and outcomes for women with a history of tamoxifen use (tamoxifen group) were compared to those who had not taken tamoxifen (non-tamoxifen group). Results A total of 614 women with post-menopausal bleeding underwent transvaginal ultrasound triage, of whom 53 had a history of current or previous tamoxifen treatment. An endometrial thickness of ≥5 mm or the presence of other abnormal features was used to triage women to further investigation by hysteroscopy and biopsy. Endometrial thickness was significantly greater in the tamoxifen group (11 mm vs. 6 mm). Nearly all of the tamoxifen group were triaged to further investigation (98.1%), compared with significantly fewer in the non-tamoxifen group (68.3%) Overall, the incidence of endometrial pathology was also significantly higher in tamoxifen patients (43.4% vs. 31.7%). Conclusion For women presenting with post-menopausal bleeding, the use of transvaginal ultrasound as a triage tool is rarely helpful in evaluating women who have a history as tamoxifen use, as most will require further investigation with hysteroscopy and biopsy. A post-menopausal bleeding protocol that omits transvaginal ultrasound for women with a history of tamoxifen use may be an appropriate and effective pathway for managing these patients.
目的 评估经阴道超声分诊在有他莫昔芬治疗史且出现绝经后出血的女性中的作用。研究设计 对出现绝经后出血症状并接受超声分诊的患者进行回顾性研究。然后将子宫内膜厚度和超声特征与宫腔镜及组织病理学结果数据进行关联。将有他莫昔芬使用史的女性（他莫昔芬组）的检查结果与未服用他莫昔芬的女性（非他莫昔芬组）的结果进行比较。结果 共有614名绝经后出血的女性接受了经阴道超声分诊，其中53名有当前或既往他莫昔芬治疗史。子宫内膜厚度≥5 mm或存在其他异常特征被用于将女性分诊至进一步进行宫腔镜检查和活检。他莫昔芬组的子宫内膜厚度明显更大（11 mm对6 mm）。几乎所有他莫昔芬组患者都被分诊至进一步检查（98.1%），相比之下，非他莫昔芬组的比例要低得多（68.3%）。总体而言，他莫昔芬治疗患者的子宫内膜病变发生率也明显更高（43.4%对31.7%）。结论 对于出现绝经后出血的女性，经阴道超声作为一种分诊工具，在评估有他莫昔芬使用史的女性时很少有帮助，因为大多数此类女性都需要进一步进行宫腔镜检查和活检。对于有他莫昔芬使用史的女性，省略经阴道超声检查的绝经后出血诊疗方案可能是管理这些患者的合适且有效的途径。
