Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, Valentin L
Department of Obstetrics and Gynecology, University of Göteborg, Sweden.
Am J Obstet Gynecol. 1995 May;172(5):1488-94. doi: 10.1016/0002-9378(95)90483-2.
The purpose of this study was to use transvaginal ultrasonographic measurements to find the thickness of the endometrium below which the risk of endometrial abnormality in women with postmenopausal bleeding is low.
This multicenter study was carried out at eight clinics in four Nordic countries. The study included 1168 women with postmenopausal bleeding scheduled for curettage Before the curettage was performed, the thickness of the endometrium was measured with transvaginal ultrasonography. The measurement included both endometrial layers (double-layer technique). The transvaginal ultrasonographic measurement was compared with the histopathologic diagnosis of the curettage specimens.
In women with atrophic endometrium the mean endometrial thickness (+/- SD) was 3.9 +/- 2.5 mm. The corresponding figures for women with endometrial cancer were 21.1 +/- 11.8 mm. No malignant endometrium was thinner than 5 mm. In 30 women (2.8%) it was not possible to measure the thickness of the endometrium; one of these women had endometrial cancer. The 95% confidence limit for the probability of excluding endometrial abnormality was 5.5% when the endometrial thickness was < or = 4 mm as measured by transvaginal ultrasonography.
The risk of finding pathologic endometrium at curettage when the endometrium is < or = 4 mm as measured by transvaginal ultrasonography is 5.5%. Thus in women with postmenopausal bleeding and an endometrium < or = 4 mm it would seem justified to refrain from curettage.
本研究的目的是通过经阴道超声测量来确定绝经后出血女性子宫内膜厚度低于何值时，子宫内膜异常风险较低。
这项多中心研究在北欧四个国家的八家诊所进行。研究纳入了1168例计划行刮宫术的绝经后出血女性。在进行刮宫术前，采用经阴道超声测量子宫内膜厚度。测量包括子宫内膜的两层（双层技术）。将经阴道超声测量结果与刮宫标本的组织病理学诊断结果进行比较。
子宫内膜萎缩的女性，平均子宫内膜厚度（±标准差）为3.9±2.5mm。子宫内膜癌女性的相应数值为21.1±11.8mm。没有恶性子宫内膜厚度小于5mm。30例女性（2.8%）无法测量子宫内膜厚度；其中1例患有子宫内膜癌。经阴道超声测量子宫内膜厚度≤4mm时，排除子宫内膜异常的概率的95%置信限为5.5%。
经阴道超声测量子宫内膜厚度≤4mm时，刮宫时发现病理性子宫内膜的风险为5.5%。因此，对于绝经后出血且子宫内膜厚度≤4mm的女性，似乎有理由不进行刮宫术。
