Pepper J M, Oyesanya O A, Dewart P J, Howell A, Seif M W
Academic Department of Obstetrics and Gynaecology, University of Manchester, UK.
Ultrasound Obstet Gynecol. 1996 Dec;8(6):408-11. doi: 10.1046/j.1469-0705.1997.08060408.x.
The aim of this study was to test the hypothesis that the use of indices of differential endometrial: myometrial growth may be a non-invasive method of improving the reliability of detecting endometrial neoplasia in women on tamoxifen. Thirty postmenopausal women were involved in this prospective study. Nineteen had been treated with tamoxifen for 2 years or more, and eleven were age- and ponderal index-matched controls who had never been exposed to tamoxifen and who were non-smokers. Transvaginal ultrasonography and color Doppler imaging were performed, to measure the length, anteroposterior diameter, uterine sagittal area, endometrial thickness and uterine blood flow (using the pulsatility index and the resistance index as measures of uterine blood flow impedance). The anteroposterior diameter: endometrial thickness ratio and product, and the saggital area: endometrial thickness ratio and product were used as indices of differential endometrial: myometrial growth. The predictive values (sensitivity, specificity, positive and negative predictive values) of each index were calculated using established criteria. For the purpose of analysis the women were allocated to three groups: controls (group 1); women on tamoxifen without endometrial neoplasia (group 2) and women on tamoxifen who developed endometrial neoplasia (group 3). The mean age was similar in the three groups as was the duration of tamoxifen treatment in groups 2 and 3. Analysis of the decision matrix based on increased endometrial thickness (> 5 mm) alone revealed good sensitivity (100%) and negative predictive value (100%) but poor specificity (46.15%) and positive predictive value (26.32%). However, when the indices of differential endometrial: myometrial growth were taken into consideration, the sensitivities and negative predictive values were similar but the specificities and positive predictive values were significantly improved, indicating an improvement in the reliability of predicting the development of endometrial neoplasia.
利用子宫内膜与肌层差异生长指数可能是一种提高他莫昔芬治疗女性子宫内膜肿瘤检测可靠性的非侵入性方法。30名绝经后女性参与了这项前瞻性研究。19名女性接受他莫昔芬治疗2年或更长时间，11名年龄和体重指数匹配的对照者从未接触过他莫昔芬且不吸烟。进行经阴道超声检查和彩色多普勒成像，以测量子宫的长度、前后径、矢状面积、子宫内膜厚度和子宫血流（使用搏动指数和阻力指数作为子宫血流阻抗的测量指标）。前后径与子宫内膜厚度的比值和乘积，以及矢状面积与子宫内膜厚度的比值和乘积被用作子宫内膜与肌层差异生长的指标。使用既定标准计算每个指标的预测值（敏感性、特异性、阳性预测值和阴性预测值）。为了进行分析，将这些女性分为三组：对照组（第1组）；接受他莫昔芬治疗但无子宫内膜肿瘤的女性（第2组）和接受他莫昔芬治疗且发生子宫内膜肿瘤的女性（第3组）。三组的平均年龄相似，第2组和第3组的他莫昔芬治疗持续时间也相似。仅基于子宫内膜厚度增加（>5mm）的决策矩阵分析显示出良好的敏感性（100%）和阴性预测值（100%），但特异性较差（46.15%）和阳性预测值（26.32%）。然而，当考虑子宫内膜与肌层差异生长指数时，敏感性和阴性预测值相似，但特异性和阳性预测值显著提高，表明预测子宫内膜肿瘤发生的可靠性有所提高。
