这项研究的主要目的是使用国际子宫内膜肿瘤分析(IETA)术语描述无异常子宫出血(AUB)的女性的各种子宫内膜和其他腔内病理的超声特征。次要目的是将我们的发现与发表的关于AUB女性的数据进行比较。
这是一项前瞻性观察性研究,研究对象是7个妇科超声检查中心之一的女性,从2011年到2018年,对于与AUB无关的适应症。所有患者均使用IETA检查和测量技术进行经阴道超声检查。超声检查作为常规妇科检查或非子宫内膜病理随访的一部分,或者作为不孕症治疗前的一部分,子宫脱垂或卵巢病理。使用IETA术语描述超声发现。超声扫描后进行子宫内膜取样。组织学终点是子宫内膜萎缩,增生性或分泌性子宫内膜,子宫内膜增生无异型,子宫内膜息肉,腔内平滑肌瘤,子宫内膜上皮内瘤变(EIN),子宫内膜癌(EC)和组织不足。我们在没有AUB的女性队列中的发现与在2012年至2015年之间使用相同的IETA检查技术和术语进行经阴道超声检查的AUB女性队列中的发现进行了比较。
在这项研究(IETA3)中,我们纳入了1,745例无AUB的女性,她们接受了标准化的经阴道超声检查,随后进行了子宫内膜取样并进行组织学诊断(n=1,537)或至少1年的临床和超声随访(n=208).其中,绝经前858例(49.2%),绝经后887例(50.8%)。组织学显示29名(1.7%)女性中存在EC和/或EIN,子宫内膜息肉1028例(58.9%),66例(3.8%)腔内肌瘤,144(8.3%)的增生或分泌变化或无异型增生,子宫内膜萎缩265例(15.2%),组织不足5例(0.3%)。大多数EC或EIN病例(25/29(86.2%))是在绝经后诊断的。EC或EIN患者的平均子宫内膜厚度为11.2mm(95%CI,8.9-13.6mm),平均厚度为2.4毫米(95%可信区间,0.3-4.6毫米),比他们的良性同行。子宫内膜恶性病变的女性表现出非均匀回声(22/29(75.9%))比子宫内膜良性病变的女性(929/1716(54.1%))(差异,+21.8%(95%CI,+4.2%至+39.2%)。在31.0%(9/29)的EC或EIN病例中观察到中度至丰富的血管化(颜色评分3-4),而良性结局的病例为12.8%(220/1716)(差异,+18.2%(95%CI,-0.5%至+36.9%)。24.1%(7/29)的EC或EIN女性与4.0%(68/1716)的良性结局(差异,+20.2%(95%CI,+4.6%至+35.7%)。在EC或EIN(19/29(65.5%))与良性结局(1412/1716(82.3%))的女性中,子宫内膜-肌层交界处的频率较低(差异,-16.8%(95%CI,-34.2%至+0.6%)。在子宫内膜息肉无AUB的女性中,单个优势血管是最常见的血管模式(666/1028(64.8%)).在患有EC的女性中,在有和没有AUB的情况下,子宫内膜通常表现为不均匀的回声,但是子宫内膜平均为8.6mm(95%CI,5.2-12.0mm),血管化程度较低(颜色评分3-4:差异,-26.8%(95%CI,-52.2%至-1.3%)的女性与AUB患者相比。在绝经前和绝经后的女性中,无症状的子宫内膜息肉与子宫内膜变薄有关,它们更频繁地表现出明亮的边缘,规则的子宫内膜-子宫肌层交界处和单个优势血管,而有症状的女性则有息肉,它们的血管化程度较低。
我们描述了EC的典型超声特征,在没有AUB的女性中使用IETA术语的息肉和其他腔内组织学。我们的发现表明,无症状性息肉或子宫内膜恶性肿瘤的存在可能伴有比有症状的子宫内膜更薄,血管化程度更低的子宫内膜。©2022国际妇产科超声学会。
The primary aim of this
study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB.
This was a prospective observational
study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology.
In this
study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized.
We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.