Gracia Meritxell, Nonell Roser, Ros Cristina, Rius Mariona, Quintas Lara, Martínez-Zamora Maria Ángeles, Carmona Francisco
Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
Eur J Obstet Gynecol Reprod Biol. 2019 Jan;232:40-45. doi: 10.1016/j.ejogrb.2018.11.009. Epub 2018 Nov 6.
Ulipristal acetate (UPA) is a progesterone receptor modulator (PRM) agent that has shown benefits in women with symptomatic uterine fibroids. However, its effects on the endometrium are complex and not fully understood. We describe exploratory findings on macroscopic observation of the endometrium at transvaginal sonography (TVS) and hysteroscopy. The aim of the study is to characterize endometrial patterns commonly observed after UPA treatment.
We performed a prospective longitudinal study at a tertiary referral center with 100 women with symptomatic uterine fibroids who received a 12-week treatment with UPA (5 mg/day). Patients underwent TVS before and after the treatment, and also a hysteroscopy examination was performed. Main outcome was to compare sonographic and hysteroscopic findings to histology after UPA treatment.
Twenty one out of 100 (21%) women showed PAEC confirmed by histology after UPA treatment. Ultrasound findings were normal in most women after UPA treatment, but 18/100 (18%) showed an endometrial pattern suggestive of PRM effects (non-uniform, homogeneous endometrium with regular cystic areas). Endometrial thickness ≥16 mm was detected in 6/100 patients (6%), and all of them also presented sonographic PRM pattern. No patient presented malignancy according to histology in this subgroup, and 100% of them had PAEC pattern at histology. Among total patient population showing PAEC at histology, only 33% of these were identified by hysteroscopy, while 57% were identified by TVS with the PRM suggestive pattern. Of note, visibility of endometrium was improved at TVS after UPA.
Identification of increased endometrial thickness together with the categorized endometrial PRM pattern at TVS may be correlated to benign lesions and may not be a cause of concern. This study is exploratory and further research is necessary to support these conclusions. Nevertheless, TVS seems to be feasible to plan adequate follow-up protocols by avoiding unnecessary interventional procedures such as hysteroscopy.
醋酸乌利司他（UPA）是一种孕激素受体调节剂（PRM），已显示对有症状的子宫肌瘤女性有益。然而，其对子宫内膜的影响复杂且尚未完全了解。我们描述了经阴道超声检查（TVS）和宫腔镜检查时对子宫内膜进行宏观观察的探索性发现。本研究的目的是描述UPA治疗后常见的子宫内膜模式特征。
我们在一家三级转诊中心对100例有症状的子宫肌瘤女性进行了一项前瞻性纵向研究，这些女性接受了为期12周的UPA治疗（5毫克/天）。患者在治疗前后接受TVS检查，并进行宫腔镜检查。主要结果是比较UPA治疗后超声和宫腔镜检查结果与组织学结果。
100名女性中有21名（21%）在UPA治疗后经组织学证实出现PAEC。UPA治疗后大多数女性的超声检查结果正常，但18/100（18%）显示出提示PRM效应的子宫内膜模式（不均匀、均匀的子宫内膜伴有规则的囊性区域）。6/100例患者（6%）检测到子宫内膜厚度≥16毫米，且所有这些患者也呈现超声PRM模式。该亚组中根据组织学没有患者出现恶性肿瘤，且其中100%在组织学上有PAEC模式。在组织学上显示PAEC的全部患者中，其中只有33%通过宫腔镜检查发现，而57%通过具有PRM提示模式的TVS发现。值得注意的是，UPA治疗后TVS检查时子宫内膜的可视性得到改善。
TVS检查时子宫内膜厚度增加以及分类的子宫内膜PRM模式可能与良性病变相关，可能无需担忧。本研究具有探索性，需要进一步研究来支持这些结论。然而，TVS似乎可行，可通过避免不必要的介入程序（如宫腔镜检查）来规划适当的随访方案。
