Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, United States of America.
Gynecol Oncol. 2020 Jun;157(3):624-633. doi: 10.1016/j.ygyno.2020.01.032. Epub 2020 Jan 31.
To assess the performance of endometrial thickness (ET) cut-offs for detecting endometrial cancer (EC) in women with postmenopausal bleeding (PMB) and evaluate the clinical utility of additional ultrasound measures such as endometrial volume (EV), vascular flow index (VFI), vascularization index (VI), and uterine artery flow index (FI).
Clinicaltrials.gov and MEDLINE database via PubMed were queried for studies published between 1/1990 and 3/2016 using specific MeSH terms. Original, peer-reviewed cohort studies reporting EC outcomes and specific ultrasound findings by PMB status were included.
Study design, country, clinical setting inclusion/exclusion criteria, aggregate study-level demographic and clinical data were extracted from 44 studies including 17,339 women with PMB and 1341 cases of EC (7.7%). In women with PMB and EC (n = 417), pooled mean ET was 16.4 mm (95% CI, 14.8-18.1 mm). In women with PMB without EC, pooled mean ET was 4.1 mm. 31 studies reported outcomes using different ET cut-off values ranging from 3 to 20 mm. Compared to ≥3 or 4 mm, a cutoff of ≥5 mm had similar sensitivity (96.2, 95%CI 92.3, 98.1) with improved specificity for EC (51.5, 95%CI 42.3-60.7), allowing to reduce the rate of invasive workup for PMB by 17%. EV, VI, VFI, and FI were significantly correlated with EC, but performance of specific cut-offs was not analyzed due to limited data.
Among women with PMB mean ET is substantially higher in women with EC compared to those without EC. An ET cutoff of ≥5 mm shows an acceptable tradeoff between sensitivity and specificity for diagnosis of EC.
评估绝经后出血（PMB）女性子宫内膜厚度（ET）截断值检测子宫内膜癌（EC）的性能，并评估子宫内膜容积（EV）、血流指数（VFI）、血管化指数（VI）和子宫动脉血流指数（FI）等额外超声测量的临床应用价值。
通过特定的 MeSH 术语，在 Clinicaltrials.gov 和 MEDLINE 数据库中检索了 1990 年 1 月至 2016 年 3 月期间发表的研究。纳入了报告 EC 结局和 PMB 状态下特定超声发现的原始、同行评审队列研究。
从包括 17339 名 PMB 女性和 1341 例 EC 患者的 44 项研究中提取了研究设计、国家、临床环境纳入/排除标准、汇总研究水平的人口统计学和临床数据。在 PMB 伴 EC（n=417）的女性中，平均 ET 为 16.4mm（95%CI，14.8-18.1mm）。在 PMB 不伴 EC 的女性中，平均 ET 为 4.1mm。31 项研究报道了使用不同 ET 截断值（3-20mm）的结果。与≥3 或 4mm 相比，截断值≥5mm 对 EC 的敏感性相似（96.2，95%CI 92.3，98.1），特异性提高（51.5，95%CI 42.3-60.7），可使 PMB 的侵入性检查率降低 17%。EV、VI、VFI 和 FI 与 EC 显著相关，但由于数据有限，未分析特定截断值的性能。
在 PMB 女性中，与不伴 EC 的女性相比，EC 女性的平均 ET 显著升高。ET 截断值≥5mm 在 EC 的诊断中具有可接受的敏感性和特异性之间的权衡。
