目的:为了确定子宫内膜厚度(ET)的临界值,提示无症状的绝经后妇女进行活检,并偶然发现子宫内膜增厚,并建立风险预测模型。
方法:这是一项回顾性队列分析,对阜兴医院宫腔镜中心的临床记录,首都医科大学,北京,中国。我们收集了无症状的绝经后妇女,这些妇女的ET≥4mm(双层)作为偶然发现。我们根据病理结果将参与者分为非恶性和恶性组,并评估两组之间的差异。采用受试者工作特征曲线(ROC)确定ET预测子宫内膜恶性程度的临界值。还构建了Logistic回归模型来预测恶性肿瘤的风险。
结果:共纳入581例连续合格病例。ET的最佳截止值为8mm,最大曲线下面积(AUC)为0.755(95%CI:0.645-0.865)。除了ET,回归模型结合了糖尿病,血流信号,BMI,和高血压来预测恶性肿瘤的风险。为模型构建的ROC曲线产生0.834的AUC(95%CI:0.744-0.924)。
结论:当ET为8mm或以上时,对无症状的绝经后妇女进行宫腔镜检查和视觉子宫内膜活检是合理的。对于ET在4到8毫米之间的人,进行活检的进一步决定应在个人基础上确定,考虑子宫内膜的危险因素和血流信号。
OBJECTIVE: To determine the cutoff value for endometrial thickness (ET) that prompts a biopsy in asymptomatic postmenopausal women with an incidental finding of thickened endometrium, and to develop a risk prediction model.
METHODS: This is a retrospective cohort analysis of the clinical records of the Hysteroscopic Center of Fu Xing Hospital, Capital Medical University, Beijing,
China. We collected asymptomatic postmenopausal women who presented with an ET of ≥4 mm (double-layer) as an incidental finding. We stratified the participants into non-malignant and malignant groups based on pathology results and assessed differences between the two groups. A receiver operating characteristic curve (ROC) was used to identify the cutoff value of ET for predicting endometrial malignancy. Logistic regression models were also constructed to predict the risk of malignancy.
RESULTS: A total of 581 consecutive eligible cases were included. The optimal cutoff value for ET was 8 mm, with a maximum area under the curve (AUC) of 0.755 (95 % CI: 0.645-0.865). In addition to ET, the regression model incorporated diabetes, blood flow signal, BMI, and hypertension to predict the risk of malignancy. A ROC curve constructed for the model yielded an AUC of 0.834 (95 % CI: 0.744-0.924).
CONCLUSIONS: It is reasonable to offer hysteroscopy and visually-directed endometrial biopsy for asymptomatic postmenopausal women when ET is 8 mm or above. For those with an ET between 4 and 8 mm, further decision to perform biopsy should be determined on an individual basis, considering risk factors and blood flow signals of the endometrium.