Cacciatore B, Ramsay T, Lehtovirta P, Ylöstalo P
Department I of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
Acta Obstet Gynecol Scand. 1994 May;73(5):413-6. doi: 10.3109/00016349409006254.
We compared transvaginal sonography and hysteroscopy with dilatation and curettage findings in 45 women with atypical postmenopausal bleedings. The histological diagnosis was atrophy in eight (17.8%) women, hormonal effects in 14 (31.1%), endometrial polyp in 19 (42.2%) and adenocarcinoma in four (8.8%). Hysteroscopy detected 16 (78.9%) of the 19 cases with polyps and two of the four with carcinoma. Sensitivity and specificity for endometrial pathology were 86.9% and 91.7% respectively. A polyp was directly diagnosed by transvaginal sonography in 13 (57.9%) women and an infiltrative endometrial cancer in two. Sensitivity and specificity for endometrial pathology were 73.9% and 95.7% respectively. All but one case of endometrial pathology were found when the endometrium (both layers) was thicker than 5 mm. Thus, an endometrial thickness of > or = 5 mm had a sensitivity of 95.7%, a specificity of 45.5% and a positive predictive value of 64.7% for endometrial pathology. This study shows that transvaginal scanning allows detection of an endometrial pathology in the vast majority of cases and it may be used as the first diagnostic step in the investigation of women with atypical postmenopausal bleeding.
我们比较了经阴道超声检查、宫腔镜检查与刮宫术结果，研究对象为45例绝经后非典型出血的女性。组织学诊断结果为：8例（17.8%）女性为萎缩，14例（31.1%）为激素影响，19例（42.2%）为子宫内膜息肉，4例（8.8%）为腺癌。宫腔镜检查发现19例息肉患者中的16例（78.9%）以及4例癌症患者中的2例。子宫内膜病变的敏感性和特异性分别为86.9%和91.7%。经阴道超声直接诊断出13例（57.9%）女性患有息肉，2例患有浸润性子宫内膜癌。子宫内膜病变的敏感性和特异性分别为73.9%和95.7%。除1例子宫内膜病变外，所有病例均在子宫内膜（两层）厚度超过5mm时被发现。因此，子宫内膜厚度≥5mm对子宫内膜病变的敏感性为95.7%，特异性为45.5%，阳性预测值为64.7%。本研究表明，经阴道扫描在绝大多数情况下能够检测出子宫内膜病变，可作为绝经后非典型出血女性检查的首要诊断步骤。
