背景:绝经后未出血的患者在超声检查中偶然发现子宫内膜增厚是妇科服务的常见表现;然而,对于何时需要宫腔镜评估和子宫内膜取样,指导临床实践的证据有限。
目的:确定超声检查子宫内膜增厚的无症状绝经后妇女子宫内膜取样的子宫内膜厚度。
方法:进行单中心回顾性病例系列的绝经后无出血妇女行宫腔镜检查。使用Logistic回归检查一系列变量与癌前或恶性病理和子宫内膜厚度之间的关联。确定最佳子宫内膜厚度阈值以最大化模型灵敏度。
结果:本研究共纳入了404名绝经后妇女,在2008年7月1日至2018年6月30日期间在研究地点接受了宫腔镜检查。患者就诊时的平均(SD)年龄为65(9.09)岁,平均体重指数为29.86kg/m2(6.52)。在这些女人中,9例(2.2%)诊断为子宫内膜癌,7例(1.7%)诊断为子宫内膜增生伴不典型.最常见的组织病理学发现是良性子宫内膜息肉(153:37.9%)。当在感兴趣的组织病理学中包括有或没有异型的增生时,在本队列中,≥9mm的截断值对于癌前病变或恶性病变的诊断具有最大的敏感性(83.3%)和特异性(63.8%)(分类准确率为64.8%;接受者操作特征下面积:0.7358,95%CI:0.6439,0.8278).
结论:使用≥9mm的子宫内膜厚度可作为绝经后无出血妇女子宫内膜取样的截止值。
An incidental finding of a thickened endometrium on ultrasound in the postmenopausal patient without bleeding is a common presentation to gynaecological services; however there is limited evidence to guide clinical practice as to when hysteroscopic evaluation and endometrial sampling is required.
To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic postmenopausal women referred with thickened endometrium on ultrasound.
A single-centre retrospective
case series of postmenopausal women without bleeding undergoing hysteroscopy was conducted. Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness. The optimal endometrial thickness threshold was identified to maximise model sensitivity.
A total of 404 postmenopausal women were included in this study, having undergone a hysteroscopy at the study site between 1 July 2008 and 30 June 2018. The mean (SD) age of patients at presentation was 65 (9.09) years and the mean body mass index was 29.86 kg/m2 (6.52). Of these women, nine (2.2%) were diagnosed with endometrial carcinoma and seven (1.7%) had endometrial hyperplasia with atypia. The most common histopathological finding was of a benign endometrial polyp (153: 37.9%). When including hyperplasia with or without atypia in histopathology of interest, a cut-off of ≥9 mm provides the greatest sensitivity (83.3%) and specificity (63.8%) for a diagnosis of pre-malignant or malignant pathology (classification accuracy of 64.8%; area under the receiver operating characteristic: 0.7358, 95% CI: 0.6439, 0.8278) in this cohort.
Using an endometrial thickness of ≥9 mm can be used as a cut-off for endometrial sampling in postmenopausal women without bleeding.