Giusa-Chiferi M G, Gonçalves W J, Baracat E C, de Albuquerque Neto L C, Bortoletto C C, de Lima G R
Department of Gynecology, Escolo Paulista de Medicina, Federal University of São Paulo, Brazil.
Int J Gynaecol Obstet. 1996 Oct;55(1):39-44. doi: 10.1016/0020-7292(96)02720-8.
To determine the importance of endometrial biopsy and transvaginal ultrasound in patients with postmenopausal bleeding.
Eighty patients with postmenopausal bleeding were submitted to transvaginal ultrasound followed by endometrial biopsy. Hysteroscopy and dilatation and curettage were carried out to confirm normality of the uterine cavity.
The endometrial echo could be visualized in all patients with postmenopausal bleeding. The biopsy failed to detect one case (1.38%) of adenocarcinoma and 14 cases (17.5%) of endometrial polyps. The sensitivity in detecting endometrial malignancy was 94.44% for endometrial biopsy and 100% for transvaginal ultrasound, when the endometrial thickness was more than 8 mm.
When the thickness of the endometrial echo is less than 3 mm there is no need for anatomopathologic investigation. When this limit was adopted, all cases were associated with endometrial atrophy, and when the limit was 4 mm or more, active endometria were detected, requiring further histopathologic investigation by hysteroscopy and directed biopsies. Above 8 mm, malignancy may be found.
确定子宫内膜活检和经阴道超声检查在绝经后出血患者中的重要性。
80例绝经后出血患者接受经阴道超声检查，随后进行子宫内膜活检。进行宫腔镜检查及刮宫术以确认宫腔正常。
所有绝经后出血患者均可观察到子宫内膜回声。活检未能检测出1例（1.38%）腺癌和14例（17.5%）子宫内膜息肉。当子宫内膜厚度超过8mm时，子宫内膜活检检测子宫内膜恶性肿瘤的敏感性为94.44%，经阴道超声检查为100%。
当子宫内膜回声厚度小于3mm时，无需进行解剖病理学检查。采用此限值时，所有病例均与子宫内膜萎缩相关；当限值为4mm或更高时，检测到活跃的子宫内膜，需要通过宫腔镜检查和定向活检进行进一步的组织病理学检查。超过8mm时，可能发现恶性肿瘤。
