Gupta J K, Wilson S, Desai P, Hau C
Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Scotland.
Acta Obstet Gynecol Scand. 1996 May;75(5):475-9. doi: 10.3109/00016349609033357.
To evaluate the optimum method(s) of investigating women with postmenopausal bleeding.
Prospective study of 76 postmenopausal women.
Teaching Hospital. Interventions. All women had pipelle endometrial biopsy in outpatient clinic. Prior to inpatient hysteroscopy and uterine curettage, each woman had pelvic ultrasonography to measure the endometrial thickness and to exclude ovarian pathology.
Pipelle biopsy was successful in 70% of cases and has a sensitivity of 70%. Hysteroscopy has superior diagnostic capabilities allowing direct visualisation of the endometrial cavity with directed biopsies. Endometrial thickness of > 5 mm used as an indicator of endometrial pathology compared to uterine curettage has a sensitivity of 83%, a specificity of 77%, and a positive predictive value of 54%. Ultrasound also detected five ovarian tumors, two of which were malignant and three missed by pelvic examination alone.
We recommend the routine use of pelvic ultrasonography in all women with postmenopausal bleeding as it is an invaluable diagnostic tool in excluding ovarian pathology. In addition, sampling of the endometrial cavity, preferably with outpatient hysteroscopy, is mandatory for histological diagnosis. Overall, the combination of ultrasound and outpatient endometrial sampling would spare hospital admission for at least 60% of women with postmenopausal bleeding.
评估调查绝经后出血女性的最佳方法。
对76名绝经后女性进行前瞻性研究。
教学医院。干预措施。所有女性均在门诊接受了 Pipelle 子宫内膜活检。在住院进行宫腔镜检查和刮宫术前，每位女性均接受盆腔超声检查以测量子宫内膜厚度并排除卵巢病变。
Pipelle活检在70%的病例中成功，敏感性为70%。宫腔镜检查具有更好的诊断能力，可直接观察子宫内膜腔并进行定向活检。与刮宫术相比，将子宫内膜厚度>5mm用作子宫内膜病变指标时，其敏感性为83%，特异性为77%，阳性预测值为54%。超声还检测出5例卵巢肿瘤，其中2例为恶性，另外3例仅通过盆腔检查漏诊。
我们建议对所有绝经后出血女性常规使用盆腔超声检查，因为它是排除卵巢病变的重要诊断工具。此外，为进行组织学诊断，必须对子宫内膜腔进行取样，最好采用门诊宫腔镜检查。总体而言，超声检查和门诊子宫内膜取样相结合可使至少60%的绝经后出血女性无需住院。
