Abstract：
BACKGROUND: Endometrial cancer (EC) is the strongest obesity-associated malignancy and the fastest-growing cancer in young women. Early identification of EC and other endometrial pathology (malignant and nonmalignant) in women with severe obesity may improve treatment options and uterine preservation. Screening for endometrial pathology using abnormal or postmenopausal uterine bleeding (APUB) as a surrogate in women pursuing metabolic/bariatric surgery may be clinically beneficial, but data supporting this effort are limited.
OBJECTIVE: To develop and institute a screening program for APUB as a surrogate for endometrial pathology in bariatric surgery candidates.
METHODS: Two, academic metabolic/bariatric surgery programs in Louisiana, United States.
METHODS: The Modified SAMANTA is a 10-item questionnaire that was implemented to identify patients with APUB, specifically combining tools designed to identify anovulatory/postmenopausal and heavy menstrual bleeding. Demographic (age, race), body mass index, and questionnaire data were analyzed with respect to positive screening using data from March 2021 through May 2023.
RESULTS: Of 1371 eligible women presenting for surgical evaluation, 664 (48.4%) positive screens were identified and referred for gynecologic evaluation to rule out endometrial hyperplasia/cancer or other endometrial pathology. The likelihood of positive screening for APUB was associated with increasing BMI (P = .001) and Black/African American race (P = .003), as well as increasing SAMANTA score (P < .001). In contrast, risk of positive screening was negatively associated with increasing age (P < .001).
CONCLUSIONS: Women presenting for metabolic/bariatric surgery have a high prevalence of APUB and, given this dysfunctional bleeding and concurrent obesity, are at greater risk for underlying EC. Potential risk factors for APUB, given their associations with screening positive, include increased body mass index, younger age, and Black/African American race. Standardized screening with appropriate gynecologic referral should be a routine part of the overall evaluation for women with severe obesity.
OBJECTIVE: To develop and institute a screening program for APUB as a surrogate for endometrial pathology in bariatric surgery candidates.
METHODS: Two, academic metabolic/bariatric surgery programs in Louisiana, United States.
METHODS: The Modified SAMANTA is a 10-item questionnaire that was implemented to identify patients with APUB, specifically combining tools designed to identify anovulatory/postmenopausal and heavy menstrual bleeding. Demographic (age, race), body mass index, and questionnaire data were analyzed with respect to positive screening using data from March 2021 through May 2023.
RESULTS: Of 1371 eligible women presenting for surgical evaluation, 664 (48.4%) positive screens were identified and referred for gynecologic evaluation to rule out endometrial hyperplasia/cancer or other endometrial pathology. The likelihood of positive screening for APUB was associated with increasing BMI (P = .001) and Black/African American race (P = .003), as well as increasing SAMANTA score (P < .001). In contrast, risk of positive screening was negatively associated with increasing age (P < .001).
CONCLUSIONS: Women presenting for metabolic/bariatric surgery have a high prevalence of APUB and, given this dysfunctional bleeding and concurrent obesity, are at greater risk for underlying EC. Potential risk factors for APUB, given their associations with screening positive, include increased body mass index, younger age, and Black/African American race. Standardized screening with appropriate gynecologic referral should be a routine part of the overall evaluation for women with severe obesity.
摘要：
背景：子宫内膜癌（EC）是与肥胖相关的最强恶性肿瘤，也是年轻女性中增长最快的癌症。严重肥胖女性早期发现EC和其他子宫内膜病理（恶性和非恶性）可能会改善治疗选择和子宫保存。在进行代谢/减肥手术的妇女中，使用异常或绝经后子宫出血（APUB）作为替代品进行子宫内膜病理学筛查可能在临床上有益，但是支持这一努力的数据是有限的。
目的：开发并建立APUB筛查计划，作为减重手术患者子宫内膜病理学的替代品。
方法：两种，路易斯安那州的学术代谢/减肥手术计划，美国。
方法：改良的SAMANTA是一项10项问卷，用于识别APUB患者，专门结合旨在识别无排卵/绝经后和重度月经出血的工具。人口统计学（年龄，race),身体质量指数,使用2021年3月至2023年5月的数据，对问卷数据进行了阳性筛查分析。
结果：在参加手术评估的1371名合格女性中，664（48.4％）阳性筛查被鉴定并转介用于妇科评估，以排除子宫内膜增生/癌症或其他子宫内膜病理。APUB阳性筛查的可能性与BMI增加（P=.001）和黑人/非裔美国人种族（P=.003）有关，以及增加SAMANTA评分（P<.001）。相比之下,筛查阳性风险与年龄增长呈负相关(P<.001).
结论：接受代谢/减肥手术的妇女APUB患病率高，鉴于这种功能失调的出血和并发的肥胖，潜在的欧共体面临更大的风险。APUB的潜在风险因素，考虑到他们与筛查阳性的关联，包括增加的体重指数，年龄较小,和黑人/非裔美国人种族。对重度肥胖妇女进行标准化筛查并进行适当的妇科转诊应成为总体评估的常规部分。
目的：开发并建立APUB筛查计划，作为减重手术患者子宫内膜病理学的替代品。
方法：两种，路易斯安那州的学术代谢/减肥手术计划，美国。
方法：改良的SAMANTA是一项10项问卷，用于识别APUB患者，专门结合旨在识别无排卵/绝经后和重度月经出血的工具。人口统计学（年龄，race),身体质量指数,使用2021年3月至2023年5月的数据，对问卷数据进行了阳性筛查分析。
结果：在参加手术评估的1371名合格女性中，664（48.4％）阳性筛查被鉴定并转介用于妇科评估，以排除子宫内膜增生/癌症或其他子宫内膜病理。APUB阳性筛查的可能性与BMI增加（P=.001）和黑人/非裔美国人种族（P=.003）有关，以及增加SAMANTA评分（P<.001）。相比之下,筛查阳性风险与年龄增长呈负相关(P<.001).
结论：接受代谢/减肥手术的妇女APUB患病率高，鉴于这种功能失调的出血和并发的肥胖，潜在的欧共体面临更大的风险。APUB的潜在风险因素，考虑到他们与筛查阳性的关联，包括增加的体重指数，年龄较小,和黑人/非裔美国人种族。对重度肥胖妇女进行标准化筛查并进行适当的妇科转诊应成为总体评估的常规部分。
