绝经后无症状子宫内膜增厚妇女的子宫内膜癌发生风险
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摘要
目的:评估绝经后无症状子宫内膜增厚患者发生子宫内膜癌的风险及相关危险因素。方法:回顾分析2013年1月1日至2016年12月31日在北京协和医院因绝经后无症状子宫内膜增厚而行宫腔镜检查的206例患者的临床资料。结果:患者的平均年龄(62.2±7.5)岁,平均绝经时间(11.5±7.4)年,平均子宫内膜厚度(9.5±3.6) mm。术后病理提示:2例(1%)子宫内膜癌、1例(0.5%)子宫内膜不典型增生,203例(98.5%)子宫内膜良性病变,包括子宫内膜息肉187例(90.8%)、萎缩性子宫内膜13例(6.3%)、增殖期子宫内膜1例(0.5%)、子宫肌瘤2例(1%)。单因素及多因素分析结果显示,年龄、孕次、产次、绝经时间、体质指数(BMI)、糖尿病、高血压、应用他莫昔芬、子宫内膜厚度均对子宫内膜癌发生风险无影响(P>0.05)。结论:绝经后无症状子宫内膜增厚患者的子宫内膜癌发生风险低,严密随诊观察是可行的。如患者出现阴道出血或内膜厚度明显增加,需行组织学诊断。
Objective: To evaluate the risk for endometrial cancer( EC) in asymptomatic postmenopausal patients with thickened endometrium at ultrasound examination and the risk factors.Methods: The clinical data of 206 postmenopausal women undertaken hysteroscopy between Jan.2013 and Dec.2016 for asymptomatic thickened endometrium( >4mm) in Peking Union Medical College Hospital were analyzed retrospectively.Results: The mean age of these patients was( 62.2±7.5) years old.The mean endometrial thickness was( 9.5±3.6) mm.The mean duration of menopausal time was( 11.5±7.4) years.Two cases( 1%) of endometrial cancer were identified,and 1 case( 0. 5%) of atypical hyperplasia was diagnosed. 203( 98.5%) cases were benign lesions included 187( 90.8%) endometrial polyps,13( 6.3%) atrophy endometrium,1( 0.5%) proliferative endometrium,2( 1%) leiomyoma.At univariate and multivariate logistic regression analysis,there were no statistically significant association between age,duration of menopausal,gravidity,parity,body mass index,hypertension,diabetes mellitus,tamoxifen using,endometrial thickness with EC( P>0.05).Conclusions: The incidence of endometrial cancer in postmenopausal women with thickened endometrium without vaginal bleeding is low and careful follow-up is feasible.If bleeding symptoms appear or there is significant change in the endometrial thickness,invasive procedure to secure a histological diagnosis should be pursued.
Objective: To evaluate the risk for endometrial cancer( EC) in asymptomatic postmenopausal patients with thickened endometrium at ultrasound examination and the risk factors.Methods: The clinical data of 206 postmenopausal women undertaken hysteroscopy between Jan.2013 and Dec.2016 for asymptomatic thickened endometrium( >4mm) in Peking Union Medical College Hospital were analyzed retrospectively.Results: The mean age of these patients was( 62.2±7.5) years old.The mean endometrial thickness was( 9.5±3.6) mm.The mean duration of menopausal time was( 11.5±7.4) years.Two cases( 1%) of endometrial cancer were identified,and 1 case( 0. 5%) of atypical hyperplasia was diagnosed. 203( 98.5%) cases were benign lesions included 187( 90.8%) endometrial polyps,13( 6.3%) atrophy endometrium,1( 0.5%) proliferative endometrium,2( 1%) leiomyoma.At univariate and multivariate logistic regression analysis,there were no statistically significant association between age,duration of menopausal,gravidity,parity,body mass index,hypertension,diabetes mellitus,tamoxifen using,endometrial thickness with EC( P>0.05).Conclusions: The incidence of endometrial cancer in postmenopausal women with thickened endometrium without vaginal bleeding is low and careful follow-up is feasible.If bleeding symptoms appear or there is significant change in the endometrial thickness,invasive procedure to secure a histological diagnosis should be pursued.
引文
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[6]Hefler L,Lafleur J,Kickmaier S,et al.Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium:data from the FAME-Endo study:an observational register study[J].Arch Gynecol Obstet,2018,298(4):813-820
[7]Ferrazzi E,Zupi E,Leone FP,et al.How often are endometrial polyps malignant in asymptomatic postmenopausal women?A multicenter study[J].Am J Obstet Gynecol,2009,200(3):235.e231-236
[8]Bel S,Billard C,Godet J,et al.Risk of malignancy on suspicion of polyps in menopausal women[J].Eur J Obstet Gynecol Reprod Biol,2017,216:138-142
[9]Yasa C,Dural O,Bastu E,et al.Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women[J].Arch Gynecol Obstet,2016,294(2):311-316
[10]Louie M,Canavan TP,Mansuria S.Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding[J].Int J Gynaecol Obstet,2016,132(3):314-317
[11]Gerber B,Krause A,Muller H,et al.Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding[J].Eur JCancer,2001,37(1):64-71
[12]Gemer O,Segev Y,Helpman L,et al.Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients?An Israeli Gynecology Oncology Group study[J].Am J Obstet Gynecol,2018,219(2):181.e181-181.e186
[13]Smith RA,Andrews KS,Brooks D,et al.Cancer screening in the United States,2017:A review of current American Cancer Society guidelines and current issues in cancer screening[J].CA Cancer J Clin,2017,67(2):100-121
[14]ACOG Committee Opinion No.734:The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding[J].Obstet Gynecol,2018,131(5):e124-e129
[2]Smith-Bindman R,Weiss E,Feldstein V.How thick is too thick?When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding[J].Ultrasound Obstet Gynecol,2004,24(5):558-565
[3]Schmidt T,Breidenbach M,Nawroth F,et al.Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium[J].Maturitas,2009,62(2):176-178
[4]Famuyide AO,Breitkopf DM,Hopkins MR,et al.Asymptomatic thickened endometrium in postmenopausal women:malignancy risk[J].J Minim Invasive Gynecol,2014,21(5):782-786
[5]Breijer MC,Peeters JA,Opmeer BC,et al.Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women:a systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2012,40(6):621-629
[6]Hefler L,Lafleur J,Kickmaier S,et al.Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium:data from the FAME-Endo study:an observational register study[J].Arch Gynecol Obstet,2018,298(4):813-820
[7]Ferrazzi E,Zupi E,Leone FP,et al.How often are endometrial polyps malignant in asymptomatic postmenopausal women?A multicenter study[J].Am J Obstet Gynecol,2009,200(3):235.e231-236
[8]Bel S,Billard C,Godet J,et al.Risk of malignancy on suspicion of polyps in menopausal women[J].Eur J Obstet Gynecol Reprod Biol,2017,216:138-142
[9]Yasa C,Dural O,Bastu E,et al.Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women[J].Arch Gynecol Obstet,2016,294(2):311-316
[10]Louie M,Canavan TP,Mansuria S.Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding[J].Int J Gynaecol Obstet,2016,132(3):314-317
[11]Gerber B,Krause A,Muller H,et al.Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding[J].Eur JCancer,2001,37(1):64-71
[12]Gemer O,Segev Y,Helpman L,et al.Is there a survival advantage in diagnosing endometrial cancer in asymptomatic postmenopausal patients?An Israeli Gynecology Oncology Group study[J].Am J Obstet Gynecol,2018,219(2):181.e181-181.e186
[13]Smith RA,Andrews KS,Brooks D,et al.Cancer screening in the United States,2017:A review of current American Cancer Society guidelines and current issues in cancer screening[J].CA Cancer J Clin,2017,67(2):100-121
[14]ACOG Committee Opinion No.734:The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding[J].Obstet Gynecol,2018,131(5):e124-e129