Tepper R, Beyth Y, Altaras M M, Zalel Y, Shapira J, Cordoba M, Cohen I
Department of Obstetrics and Gynecology, Sapir Medical Center, Israel.
Gynecol Oncol. 1997 Mar;64(3):386-91. doi: 10.1006/gyno.1996.4568.
A prospective study was performed to assess the efficacy of sonohysterography (SHG) in identifying endometrial pathologies among asymptomatic, postmenopausal breast cancer patients treated with tamoxifen. In this study the uterine cavity of 68 such patients with endometrial thickness of > or = 8 mm was prospectively evaluated by SHG. Forty-six (67.6%) patients in whom SHG did not identify any findings in the uterine cavity (negative group) were followed by diagnostic hysteroscopy. Another 22 (32.4%) who were identified by SHG to have abnormal endometrial findings, such as an echogenic or polypoid mass (positive group), were followed by operative hysteroscopy and by postoperative SHG. In the positive group the basal transvaginal sonogram revealed an endometrial echogenic mass in only 10 (45.5%). In the remaining 12 (54.5%) patients, the transvaginal sonogram identified only thick endometrium. In these latter 12 patients, histological assessment confirmed endometrial polyps in 8 (66.7%) and fibroid in 1 (8.3%). Four (18.2%) patients in the positive group had no histological endometrial pathology. Two (50%) of them had a uterine septum as diagnosed during hysteroscopy, in one (25%) operative hysteroscopy failed to resect the endometrial polyp, and in another (25%) there was a false-positive SHG diagnosis. Overall, SHG accurately diagnosed endometrial and/or other intrauterine pathology in 95.5% of these patients. In the 46 patients with "negative" basal SHG features, diagnostic hysteroscopy confirmed this diagnosis. Thus, there was no SHG false-negative diagnosis. Comparing the results of the basal SHG with those of operative hysteroscopy and/or the histopathological findings in the positive group, the sensitivity of SHG was 1.0, the specificity 0.0, positive predictive value 95.5%, and negative predictive value 0.0. It is suggested that SHG is a useful diagnostic tool for the assessment of specific endometrial pathologies in asymptomatic postmenopausal breast cancer patients treated with tamoxifen who were diagnosed by transvaginal sonography to have thick endometrium.
进行了一项前瞻性研究，以评估超声子宫造影（SHG）在识别接受他莫昔芬治疗的无症状绝经后乳腺癌患者子宫内膜病变方面的疗效。在本研究中，对68例子宫内膜厚度≥8mm的此类患者的子宫腔进行了前瞻性SHG评估。46例（67.6%）SHG未发现子宫腔有任何异常的患者（阴性组）随后接受了诊断性宫腔镜检查。另外22例（32.4%）经SHG检查发现有子宫内膜异常，如回声团或息肉样肿物的患者（阳性组），随后接受了手术宫腔镜检查及术后SHG检查。在阳性组中，基础经阴道超声仅在10例（45.5%）患者中显示有子宫内膜回声团。在其余12例（54.5%）患者中，经阴道超声仅发现子宫内膜增厚。在这12例患者中，组织学评估证实8例（66.7%）为子宫内膜息肉，1例（8.3%）为肌瘤。阳性组中有4例（18.2%）患者无组织学上的子宫内膜病变。其中2例（50%）在宫腔镜检查时诊断为子宫纵隔，1例（25%）手术宫腔镜未能切除子宫内膜息肉，另l例（25%）为SHG假阳性诊断。总体而言，SHG在95.5%的此类患者中准确诊断出了子宫内膜和/或其他子宫内病变。在46例基础SHG表现为“阴性”的患者中，诊断性宫腔镜检查证实了这一诊断。因此，没有SHG假阴性诊断。将基础SHG的结果与阳性组手术宫腔镜检查结果和/或组织病理学结果进行比较显示，SHG敏感性为1.0，特异性为0.0，阳性预测值为95.5%，阴性预测值为0.0。提示SHG是一种有用的诊断工具，可用于评估经阴道超声诊断为子宫内膜增厚的无症状绝经后乳腺癌他莫昔芬治疗患者的特定子宫内膜病变。
