Persiani P, Perotti F, Riccardi A, Gallina D, Polatti F, Zara C
Clinica Ostetrica e Ginecologica, Università degli Studi di Pavia.
Minerva Ginecol. 1995 Mar;47(3):63-7.
Abnormal uterine bleeding is one of the main indications for hysteroscopy in peri-menopausal age. Transvaginal ultrasound allows for an accurate study of the endometrium through the evaluation of thickness, homogeneity. The aim of this retrospective study was the evaluation of transvaginal ultrasound versus hysteroscopy in diagnostic approach to abnormal uterine bleeding in peri- and post-menopause. 130 Women referred to the Department of Obstetrics and Gynecology of the University of Pavia for abnormal uterine bleeding entered the study; all them underwent transvaginal ultrasound and hysteroscopy with directed biopsy, with histological diagnosis of benign endometrial disease. On the basis of endometrial thickness measured at ultrasound, premenopausal patients were divided into two groups, post menopausal patients into three groups, and for each group a comparison between hysteroscopic findings, histological diagnosis and echographic aspect was performed. A 100% correspondence between ultrasound, hysteroscopy and histology was found in the group of subjects with endometrial atrophy, with an endometrial thickness of 2.9 +/- 0.68 at ultrasound; in the remaining groups sensibility and specificity of transvaginal ultrasound seem to be lower. In our experience a cut-off of 4 mm can be established for endometrial thickness measured by transvaginal ultrasound. Values that are below this cut-off point are diagnostic for endometrial atrophy, precluding the need for more invasive examinations: a medical treatment can then be administered. On the contrary, an endometrial thickening of 4 mm or more requires an hysteroscopic examination with directed biopsy and histological diagnosis.
异常子宫出血是围绝经期宫腔镜检查的主要指征之一。经阴道超声通过评估子宫内膜厚度、均匀性，能够准确地对其进行研究。本回顾性研究的目的是评估经阴道超声与宫腔镜检查在围绝经期和绝经后异常子宫出血诊断方法中的应用。130名因异常子宫出血转诊至帕维亚大学妇产科的女性进入了该研究；她们均接受了经阴道超声检查和宫腔镜直视活检，并进行了良性子宫内膜疾病的组织学诊断。根据超声测量的子宫内膜厚度，将绝经前患者分为两组，绝经后患者分为三组，并对每组患者的宫腔镜检查结果、组织学诊断和超声图像进行了比较。在子宫内膜萎缩的受试者组中，超声、宫腔镜检查和组织学检查结果的符合率为100%，超声测量的子宫内膜厚度为2.9±0.68；在其余组中，经阴道超声的敏感性和特异性似乎较低。根据我们的经验，经阴道超声测量的子宫内膜厚度可以设定4mm的临界值。低于该临界值的数值可诊断为子宫内膜萎缩，无需进行更具侵入性的检查，随后可进行药物治疗。相反，子宫内膜增厚4mm或以上则需要进行宫腔镜直视活检和组织学诊断。
