Mele G A, Pirosu T, Orru M C
Centro Prevenzione Tumori, Azienda Sanitaria n. 5 della Sardegna, Oristano.
Minerva Ginecol. 1997 Apr;49(4):133-7.
Endometrial carcinoma is presently the most frequent malignant tumor of the female genital tract. In most cases it concerns menopausal women mostly affected by chronic hyperestrogenism not balanced by progesterone. Among the useful techniques for early diagnosis in asymptomatic postmenopausal patients, only echography and hysteroscopy have obtained high reliability levels. Particularly the echographic evaluation of the endometrial thickness is the technique on which the screening of asymptomatic patients should concentrate. Nonetheless its employment on so many people would involve too expensive a social cost.
In the attempt to identify a limited group of patients to undergo the echographic test, the authors have determined, in a group of 330 asymptomatic postmenopausal women, the maturation degree of squamous cells in PAP-Smear executed for the prevention of the cervical carcinoma, in order to select subjects through a suitable estrogenic stimulation. In cases of high maturation degree (16%) and in a compared group of examinations, a progestin test (MAP-Test) has been carried out to verify the presence of possible pathological endometrial proliferation. They have thus identified a small group of asymptomatic women (6%) to undergo transvaginal echography. In this way 1.8% of the examined patients have undergone hysteroscopy with guided biopsy because of a high risk of carcinoma.
The prevalence of endometrial carcinoma so detected was 3/1000.
The authors, intend to continue their experience, end by hoping that protocol adopted by them, should become part of a global prevention program for gynecological oncology.
子宫内膜癌是目前女性生殖道最常见的恶性肿瘤。在大多数情况下，患者为绝经后女性，多受慢性雌激素过多且无孕激素平衡的影响。在无症状绝经后患者的早期诊断有用技术中，只有超声检查和宫腔镜检查具有较高的可靠性。特别是子宫内膜厚度的超声评估是无症状患者筛查应重点关注的技术。然而，对如此众多的人进行该项检查会涉及过高的社会成本。
为了确定一组有限的患者进行超声检查，作者在330名无症状绝经后女性中，检测了为预防宫颈癌而进行的巴氏涂片检查中鳞状细胞的成熟度，以便通过适当的雌激素刺激来选择受试者。在成熟度高的病例（16%）以及一组对照检查中，进行了孕激素试验（MAP试验）以验证是否存在可能的病理性子宫内膜增生。他们由此确定了一小群无症状女性（6%）进行经阴道超声检查。通过这种方式，1.8%的受检患者因患癌风险高而接受了宫腔镜引导下活检。
如此检测出的子宫内膜癌患病率为3/1000。
作者打算继续他们的经验，最后希望他们采用的方案应成为妇科肿瘤全球预防计划的一部分。
