Conoscenti G, Meir Y J, Fischer-Tamaro L, Maieron A, Natale R, D'Ottavio G, Rustico M, Mandruzzato G
Department of Obstetrics and Gynecology, Burlo Institute, Trieste, Italy.
Ultrasound Obstet Gynecol. 1995 Aug;6(2):108-15. doi: 10.1046/j.1469-0705.1995.06020108.x.
A total of 149 women with postmenopausal bleeding underwent transvaginal sonography, hysteroscopy and dilatation and curettage in order to study the diagnostic accuracy of several ultrasound parameters in assessing endometrial pathology and to determine the most sensitive cut-off value of endometrial thickness for the exclusion of endometrial lesions. In distinguishing pathological from normal endometrium, transvaginal sonography showed a sensitivity of 69.3%, specificity of 82.7%, positive predictive value of 74.1% and negative predictive value of 72.1%. In detecting premalignant and malignant endometrial pathology, transvaginal sonography showed a sensitivity, specificity, positive predictive value and negative predictive value of 55%, 96.1%, 68.7% and 93.2%, respectively. Considering endometrial thickness as a single parameter, the most sensitive cut-off for defining normality was 4 mm; nevertheless, in the group of patients that had an endometrial thickness less than 4 mm, there was one case of malignancy (sensitivity, 95.2%; specificity, 49.4%; positive predictive value, 57.3%; and negative predictive value, 93.5%). Transvaginal sonography combined evaluation (morphology, thickness and color Doppler) showed a poor diagnostic accuracy in detecting endometrial pathology and in differentiating between endometrial benign lesions, endometrial polyps and adenocarcinoma in women with postmenopausal bleeding. Endometrial thickness evaluated with transvaginal sonography was preferable but not sensitive enough to exclude endometrial pathology.
共有149例绝经后出血的女性接受了经阴道超声检查、宫腔镜检查以及刮宫术，目的是研究几种超声参数在评估子宫内膜病变方面的诊断准确性，并确定用于排除子宫内膜病变的子宫内膜厚度的最敏感临界值。在区分病理性子宫内膜与正常子宫内膜时，经阴道超声检查显示其敏感性为69.3%，特异性为82.7%，阳性预测值为74.1%，阴性预测值为72.1%。在检测子宫内膜癌前病变和恶性病变时，经阴道超声检查显示其敏感性、特异性、阳性预测值和阴性预测值分别为55%、96.1%、68.7%和93.2%。将子宫内膜厚度作为单一参数时，界定正常的最敏感临界值为4 mm；然而，在子宫内膜厚度小于4 mm的患者组中，有1例恶性病变（敏感性为95.2%；特异性为49.4%；阳性预测值为57.3%；阴性预测值为93.5%）。经阴道超声检查的综合评估（形态、厚度和彩色多普勒）在检测绝经后出血女性的子宫内膜病变以及区分子宫内膜良性病变、子宫内膜息肉和腺癌方面显示出较差的诊断准确性。经阴道超声检查评估的子宫内膜厚度是可取的，但在排除子宫内膜病变方面不够敏感。
