宫腔镜对绝经后无症状子宫内膜增厚的诊断意义
|
摘要
目的:探讨宫腔镜在绝经后子宫内膜增厚中的诊断意义,以及临床干预指征和处理方式。方法:选取2012年10月至2018年3月在上海交通大学附属瑞金医院行宫腔镜手术的绝经后无症状的子宫内膜增厚(经阴道超声检查子宫内膜厚度>5mm)患者261例。分析子宫内膜病理和子宫内膜厚度、B超影像特征及其与患者一般情况的关系。结果:261例患者的平均年龄(62.47±6.99)岁,平均绝经时间(11.78±7.48)年,平均子宫内膜厚度(10.63±4.48) mm。261例患者中,最常见的病理类型为子宫内膜息肉190例(72.8%),子宫内膜癌7例(2.7%)。正常子宫内膜、内膜良性病变、恶性病变的子宫内膜厚度分别为(8.17±2.11) mm、(10.63±4.43) mm、(16.29±6.55) mm,差异有统计学意义(P<0.01)。根据宫腔镜病理结果作ROC曲线,以子宫内膜厚度11.5mm为界值预测子宫内膜不典型增生或子宫内膜癌,敏感度为85.71%,特异度为70.47%。子宫内膜厚度及病理类型与患者年龄、生育史、BMI、高血压史、糖尿病史、高脂血症、乳腺癌病史。均无显著相关。绝经5年内的无症状子宫内膜增厚患者的内膜恶性病变比率可能相对较高。261例患者中,145例(55.6%)超声提示宫腔异常回声,116例未提示宫腔占位。超声有或无宫腔占位的病理类型分布比较,差异无统计学意义(P>0.05)。结论:绝经后无症状子宫内膜增厚最常见的病理为内膜息肉,无论超声是否仅提示内膜增厚或提示合并宫腔占位。对于息肉和其余病变,宫腔镜是准确的诊断方法。对于子宫内膜显著增厚的患者,内膜厚度超过11.5mm提示子宫内膜不典型增生或内膜癌的风险,建议临床干预。
Objective: To retrospectively analyze the clinical pathological data to confirm the significance of diagnosis and clinical intervention of hysteroscopy in postmenopausal women with asymptomatic thickened endometrium.Methods: A retrospective study was conducted of the patients between Oct. 2012 and Mar. 2018 in Ruijin Hospital. The postmenopausal women with asymptomatic thickened endometrium of more than 5mm found by transvaginal ultrasonography treated by hysteroscopy were recruited.The relationship between the pathological findings and endometrium thickness,untrasonographic features and general condition of the patients were analyzed.Results: A total of 261 patients were recruited.The average age was( 62.47±6.99) years old,the average menopause period was( 11.78±7.48) years,and the average endometrium thickness was( 10.63±4.48) mm.In 261 cases,the most common pathological type was endometrial polyp,accounting for 72.8%( 190/261) of all patients.Seven cases( 2.7%) of endometrial hyperplasia and malignant lesions were diagnosed. The endometrial thickness in normal endometrium,benign endometrial lesion and malignant lesion was( 8.17±2.11) mm,( 10.63±4.43) mm,( 16. 29 ± 6. 55) mm,respectively,which was significant different( P < 0. 01). The ROC analysis showed the cut off value for predicting endometrial hyperplasia/carcinoma was11.5mm,with the sensitivity of 85.71% and the specificity of 70.47%.There was no significant correlation between endometrial thickness/pathological type and the age,reproductive history,BMI,hypertension,diabetes,hyperlipidemia and history of breast cancer.The pathological distribution was not different in patients with( 145 cases) or without abnormal echoes( 116 cases)detected by ultrasound.Conclusion: The most common pathological type of asymptomatic thickened endometrium in postmenopausal women is endometrial polyp,no matter whether the abnormal echo was detected or not by ultrasound.Hysteroscopy is an accurate method to diagnose polyps as well as other lesions. In our opinion,clinical intervention is recommended for patients with obvious thickened endometrium,which especially exceeds 11.5mm.
Objective: To retrospectively analyze the clinical pathological data to confirm the significance of diagnosis and clinical intervention of hysteroscopy in postmenopausal women with asymptomatic thickened endometrium.Methods: A retrospective study was conducted of the patients between Oct. 2012 and Mar. 2018 in Ruijin Hospital. The postmenopausal women with asymptomatic thickened endometrium of more than 5mm found by transvaginal ultrasonography treated by hysteroscopy were recruited.The relationship between the pathological findings and endometrium thickness,untrasonographic features and general condition of the patients were analyzed.Results: A total of 261 patients were recruited.The average age was( 62.47±6.99) years old,the average menopause period was( 11.78±7.48) years,and the average endometrium thickness was( 10.63±4.48) mm.In 261 cases,the most common pathological type was endometrial polyp,accounting for 72.8%( 190/261) of all patients.Seven cases( 2.7%) of endometrial hyperplasia and malignant lesions were diagnosed. The endometrial thickness in normal endometrium,benign endometrial lesion and malignant lesion was( 8.17±2.11) mm,( 10.63±4.43) mm,( 16. 29 ± 6. 55) mm,respectively,which was significant different( P < 0. 01). The ROC analysis showed the cut off value for predicting endometrial hyperplasia/carcinoma was11.5mm,with the sensitivity of 85.71% and the specificity of 70.47%.There was no significant correlation between endometrial thickness/pathological type and the age,reproductive history,BMI,hypertension,diabetes,hyperlipidemia and history of breast cancer.The pathological distribution was not different in patients with( 145 cases) or without abnormal echoes( 116 cases)detected by ultrasound.Conclusion: The most common pathological type of asymptomatic thickened endometrium in postmenopausal women is endometrial polyp,no matter whether the abnormal echo was detected or not by ultrasound.Hysteroscopy is an accurate method to diagnose polyps as well as other lesions. In our opinion,clinical intervention is recommended for patients with obvious thickened endometrium,which especially exceeds 11.5mm.
引文
[1]Wolfman W.No.249-Asymptomatic endometrial thickening[J].J Obstet Gynaecol Can,2018,40(5):e367-e377
[2]Wolfman W,Leyland N,Heywood M,et al.Asymptomatic endometrial thickening[J].J Obstet Gynaecol Can,2010,32(10):990-999
[3]Vuento MH,Pirhonen JP,Makinen JI,et al.Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography[J].Br J Obstet Gynaecol,1999,106(1):14-20
[4]Ciatto S,Cecchini S,Bonardi R,et al.A feasibility study of screening for endometrial carcinoma in postmenopausal women by ultrasonography[J].Tumori,1995,81(5):334-337
[5]Gambacciani M,Monteleone P,Ciaponi M,et al.Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal woman[J].Maturitas,2004,48(4):421-424
[6]Gerber B,Krause A,Mueller H,et al.Ultrasonographic decection 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
[7]苏佩红.绝经后无症状子宫内膜增厚的临床分析[J].现代妇产科进展,2014,23(4):326-328
[8]Smithbindman R,Kerlikowske K,Feldstein VA,et al.Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities.[J].JAMA,1998,280(17):1510-1517
[9]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.e1-6
[10]Gregoriou O,Konidaris S,Vrachnis N,et al.Clinical parameters linked with malignancy in endometrial polyps[J].Climact,2009,12(5):454-458
[11]Soucie JE,Chu PA,Ross S,et al.The risk of diagnositic hysteroscopy in women with endometrial cancer[J].Am JObstet Gynecol,2012,207(1):71.e1-5
[12]Stachowicz N,Mazurek D,Lozinski T,et al.Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer[J].Ginekol Pol,2017,88(10):562-567
[13]李小毛,杨晓辉,杨越波,等.宫腔镜辅助分段诊刮术在子宫内膜癌诊断中的价值[J].中华妇产科杂志,2015,50(2):120-124
[14]Andolf E,Dahlander K,Aspenberg P.Ultrasonic thickness of the endometrium correlated to body weight in asymptomatic postmenopausal women[J].Obstet Gynecol,1993,82(6):936-940
[15]Gull B,Karlsson B,Milsom I,et al.Transvaginal sonography of the endometrium in a representative sample of postmenopausal women[J].Ultrasound Obstet Gynecol,1996,7(5):322-327
[2]Wolfman W,Leyland N,Heywood M,et al.Asymptomatic endometrial thickening[J].J Obstet Gynaecol Can,2010,32(10):990-999
[3]Vuento MH,Pirhonen JP,Makinen JI,et al.Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography[J].Br J Obstet Gynaecol,1999,106(1):14-20
[4]Ciatto S,Cecchini S,Bonardi R,et al.A feasibility study of screening for endometrial carcinoma in postmenopausal women by ultrasonography[J].Tumori,1995,81(5):334-337
[5]Gambacciani M,Monteleone P,Ciaponi M,et al.Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal woman[J].Maturitas,2004,48(4):421-424
[6]Gerber B,Krause A,Mueller H,et al.Ultrasonographic decection 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
[7]苏佩红.绝经后无症状子宫内膜增厚的临床分析[J].现代妇产科进展,2014,23(4):326-328
[8]Smithbindman R,Kerlikowske K,Feldstein VA,et al.Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities.[J].JAMA,1998,280(17):1510-1517
[9]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.e1-6
[10]Gregoriou O,Konidaris S,Vrachnis N,et al.Clinical parameters linked with malignancy in endometrial polyps[J].Climact,2009,12(5):454-458
[11]Soucie JE,Chu PA,Ross S,et al.The risk of diagnositic hysteroscopy in women with endometrial cancer[J].Am JObstet Gynecol,2012,207(1):71.e1-5
[12]Stachowicz N,Mazurek D,Lozinski T,et al.Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer[J].Ginekol Pol,2017,88(10):562-567
[13]李小毛,杨晓辉,杨越波,等.宫腔镜辅助分段诊刮术在子宫内膜癌诊断中的价值[J].中华妇产科杂志,2015,50(2):120-124
[14]Andolf E,Dahlander K,Aspenberg P.Ultrasonic thickness of the endometrium correlated to body weight in asymptomatic postmenopausal women[J].Obstet Gynecol,1993,82(6):936-940
[15]Gull B,Karlsson B,Milsom I,et al.Transvaginal sonography of the endometrium in a representative sample of postmenopausal women[J].Ultrasound Obstet Gynecol,1996,7(5):322-327