Nicholls-Dempsey Laura, Kamga-Ngande Carole, Bélisle Serge, Lapensée Louise, Roy Geneviève, Tremblay Catherine, Simard-Émond Laurence
Université de Montréal, Montréal, QC.
Centre Hospitalier de l'Université de Montréal, Montréal, QC; Département d'obstétrique-gynécologie de l'Université de Montréal, Montréal, QC.
J Obstet Gynaecol Can. 2018 Oct;40(10):1309-1314. doi: 10.1016/j.jogc.2018.01.020. Epub 2018 Jun 21.
We reviewed the indications for endometrial biopsy at the general gynaecology outpatient clinic of the Université de Montréal Hospital Center and measured their compliance with the Society of Obstetricians and Gynaecologists of Canada and other international guidelines.
Three hundred and seventy-one files of patients who had an endometrial biopsy between January and October 2015 were reviewed. Indication for endometrial biopsy and pathology results were noted. Files were separated into four categories.
In the postmenopausal bleeding category, all files complied with the SOGC. We found hyperplasia or neoplasia in 13% of patients. In the asymptomatic endometrial thickening category, 9% of the files did not show sufficient indication for biopsy. None of the patients presented hyperplasia or neoplasia. In the abnormal uterine bleeding (AUB) - under 41 years old category, there was no indication for biopsy in 23% of the files. We found hyperplasia or neoplasia in 13% of patients, but only in patients with an indication for biopsy. In patients with AUB - over 40, non-compliance with SOGC was 3%. But according to international guidelines, 42% of patients with AUB between 41 and 45 years old did not have an indication for biopsy and none showed hyperplasia or neoplasia.
We demonstrated clinically significant overinvestigation in patients with AUB. Indications should be reviewed carefully before performing an endometrial biopsy in women under 41. In addition, the value of endometrial biopsies in patients between 41 and 45 years old with menorrhagia and no additional risk factor should be reevaluated.
我们回顾了蒙特利尔大学医院中心普通妇科门诊进行子宫内膜活检的指征，并评估其与加拿大妇产科医师协会及其他国际指南的符合情况。
回顾了2015年1月至10月间371例接受子宫内膜活检患者的病历。记录子宫内膜活检的指征及病理结果。病历分为四类。
在绝经后出血类别中，所有病历均符合加拿大妇产科医师协会的标准。我们在13%的患者中发现了增生或肿瘤。在无症状子宫内膜增厚类别中，9%的病历未显示足够的活检指征。所有患者均未出现增生或肿瘤。在41岁以下异常子宫出血（AUB）类别中，23%的病历无活检指征。我们在13%的患者中发现了增生或肿瘤，但仅在有活检指征的患者中。在40岁以上AUB患者中，不符合加拿大妇产科医师协会标准的比例为3%。但根据国际指南，41至45岁AUB患者中有42%无活检指征，且均未出现增生或肿瘤。
我们证明了AUB患者存在临床上显著的过度检查。在对41岁以下女性进行子宫内膜活检前，应仔细审查指征。此外，对于41至45岁月经过多且无其他危险因素的患者，应重新评估子宫内膜活检的价值。
