Dubinsky T J, Parvey H R, Gormaz G, Curtis M, Maklad N
Department of Radiology, University of Texas-Houston, LBJ General Hospital 77026, USA.
J Ultrasound Med. 1995 Dec;14(12):887-93. doi: 10.7863/jum.1995.14.12.887.
Transvaginal sonography is a highly sensitive method for detecting endometrial thickening. In the postmenopausal woman such thickening is non-specific and can be due to hyperplasia, polyps, submucosal endoluminal fibroids, or carcinoma. In such cases, transvaginal sonography combined with transvaginal hysterosonography may assist in the workup of these endometrial processes. We compared the combination of transvaginal sonography and transvaginal hysterosonography to aspiration endometrial biopsy in the evaluation of women with postmenopausal bleeding. We prospectively performed transvaginal sonography in 148 women within 1 month (range, 10 days to 2 months) after having had an aspiration endometrial biopsy. Transvaginal hysterosonography was then performed in 81 of these women who had endometrial thickness greater than 5 mm. In these 81 patients, transvaginal hysterosonography confirmed 45 lesions: 23 pedunculated endometrial masses and 22 inhomogeneous sessile lesions. Women with positive transvaginal hysterosonography examinations then underwent hysteroscopy or hysterectomy, whereas women with negative examinations were followed conservatively. Forty-one of the 45 cases with endoluminal masses on transvaginal hysterosonography had false-negative aspiration biopsies. Of the five (11%) lesions that were malignant, three resulted in false-negative biopsies, one biopsy revealed hyperplasia, and only one biopsy was true positive. All 36 women with negative transvaginal hysterosonography examinations also had negative biopsy findings. We conclude that the combination of transvaginal sonography and transvaginal hysterosonography is more sensitive in the detection of endometrial pathologic lesions than is endometrial biopsy, and that transvaginal sonography or transvaginal hysterosonography should be included in the evaluation of women with postmenopausal bleeding.
经阴道超声检查是检测子宫内膜增厚的一种高度敏感的方法。在绝经后女性中，这种增厚是非特异性的，可能是由于增生、息肉、黏膜下腔内肌瘤或癌所致。在这些情况下，经阴道超声检查联合经阴道子宫超声造影可能有助于对这些子宫内膜病变进行检查。我们比较了经阴道超声检查和经阴道子宫超声造影联合检查与子宫内膜抽吸活检在绝经后出血女性评估中的效果。我们前瞻性地对148名在进行子宫内膜抽吸活检后1个月内（范围为10天至2个月）的女性进行了经阴道超声检查。然后，对其中81名子宫内膜厚度大于5mm的女性进行了经阴道子宫超声造影检查。在这81名患者中，经阴道子宫超声造影确诊了45个病变：23个有蒂子宫内膜肿物和22个不均匀的无蒂病变。经阴道子宫超声造影检查阳性的女性随后接受了宫腔镜检查或子宫切除术，而检查阴性的女性则进行保守随访。经阴道子宫超声造影显示有腔内肿物的45例病例中，有41例子宫内膜抽吸活检为假阴性。在5个（11%）恶性病变中，3例活检为假阴性，1例活检显示增生，只有1例活检为真阳性。经阴道子宫超声造影检查阴性的所有36名女性活检结果也均为阴性。我们得出结论，经阴道超声检查和经阴道子宫超声造影联合检查在检测子宫内膜病理病变方面比子宫内膜活检更敏感，并且经阴道超声检查或经阴道子宫超声造影应纳入绝经后出血女性的评估中。
