绝经后无症状子宫内膜增厚的临床分析

<正>近年,绝经后子宫内膜增厚的患者逐渐增多。有学者建议,行宫腔镜检查或诊断性刮宫,以便早期发现子宫内膜癌及癌前病变。绝经后无阴道出血等症状而仅B超检查发现的子宫内膜增厚的患者,宫腔镜检查或诊断性刮宫结果显示,子宫内膜的病理性变化少,恶性病变更少[1-4]。因此这部分患者是否需行宫腔镜检查或诊断性刮宫,意见尚不一致。本文通过回顾分析我院216例绝经后无症状子宫内膜增厚患者的临     

子宫内膜厚度能否做为绝经后阴道出血妇女内膜癌筛查指标

对绝经后出血的妇女通过超声检查测量子宫内膜厚度,以决定是否行诊刮术除外内膜癌。但其价值还不十分清楚。为此复习自1991年1月1日～1997年9月30日间MED-LINE数据库中用英文发表的以“阴道超声影像”或“子宫内膜厚度测定”为关键词的文章共48篇,并向文章作者发出问     

绝经后子宫内膜增厚及宫腔占位用于预测子宫内膜癌的阈值探讨

目的:探讨绝经后子宫内膜厚度及宫腔内病灶大小用于预测子宫内膜不典型增生(AH)及子宫内膜癌(EC)最佳阈值和AH及EC的高危因素。方法:回顾性分析2016年1月1日至2020年12月31日在复旦大学附属金山医院就诊,因各种原因行宫腔镜诊刮及子宫内膜病灶切除的绝经后女性共533例。分析其临床病理资料,二项Logistic回归分析AH及EC的危险因素。按有无绝经后出血(PMB)分为两个亚组,分别行受试者工作特征(ROC)曲线分析子宫内膜厚度和病灶大小的最佳阈值。结果:(1)AH及EC的发生率4.32%,PMB患者和无PMB患者AH及EC的发生率分别为8.18%和2.67%。(2)二项Logistic回归分析显示,子宫内膜增厚、病灶较大、内膜边界不清、内膜血流信号丰富是AH及EC的独立危险因素(OR>1,P<0.05)。(3)ROC曲线分析显示：子宫内膜厚度最佳阈值,非PMB患者为9.8 mm, AUC为0.718,敏感度66.7%,特异度78.7%;PMB患者为7.0 mm, AUC为0.832,敏感度85.7%,特异度76.0%。病灶大小最佳阈值,非PMB患者为12.7 mm...     

绝经后子宫内膜增厚与子宫内膜病变的相关性研究

目的:探讨绝经后子宫内膜增厚与子宫内膜病变的相关性,重点探讨无症状子宫内膜增厚预测内膜恶变风险的内膜厚度阈值.方法:选择245例绝经后经阴道超声检查提示子宫内膜厚度≥5 mm的患者作为研究对象,分为绝经后出血(PMB)组(124例)和无PMB组(121例),均行宫腔镜下子宫内膜活检,分析其临床病理资料.结果:①PMB组...     

绝经后子宫内膜息肉合并子宫内膜不典型增生及子宫内膜癌高危因素分析

目的分析绝经后妇女子宫内膜息肉(endometrial polyps,EMPs)发生恶变的相关危险因素。方法回顾性分析2001年4月至2009年12月北京大学人民医院妇产科收治的489例经宫腔镜病理确诊为EMPs的患者,依据病理类型分为良性组(471例)和非典型增生/恶性组(18例),比较两组患者的临床特征和子宫内膜息肉恶变的相关危险因素。结果绝经后子宫内膜息肉患者中,子宫内膜息肉合并不典型增生者11例(2.20%,11/489),子宫内膜息肉合并子宫内膜癌者7例(1.43%,7/489)。单因素分析的各临床因素中,绝经≥10年(OR=15.60,95%CI:2.05～118.57)和绝经后出血(OR=4.08,95%CI:1.31～12.70)是与子宫内膜癌前病变或子宫内膜癌相关的危险因素(P<0.05),而高血压、糖尿病、肥胖和子宫内膜息肉病史等因素比较,差异无统计学意义(P>0.05)。结论绝经后子宫内膜息肉发生癌前病变和子宫内膜癌风险增加,绝经≥10年和有绝经后出血症状是发生癌前病变和癌的危险因素。     

影响绝经后妇女内膜厚度及子宫大小的因素

为了解经阴道超声检查证实子宫内膜癌的高危因素:如肥胖、初潮早、未产、不孕、晚绝经、糖尿病、高血压、HRT等与     

绝经后妇女子宫内膜复合回声厚度对Ⅱ型子宫内膜癌预测价值研究北大核心CSCD

目的探讨绝经后妇女子宫内膜复合回声(EEC)厚度对Ⅱ型子宫内膜癌的预测价值。方法选择2010年1月至2015年1月四川省肿瘤医院术前接受超声检查的205例绝经后子宫内膜癌患者,以活检或子宫切除术后组织病理学为标准,回顾性对比分析Ⅰ型(121例)和Ⅱ型(84例)子宫内膜癌超声特点,对EEC厚度、是否有宫腔内积液或病变、子宫肌层肿物、子宫大小和附件肿物及绝经后阴道流血与发生子宫内膜癌的相关因素进行分析。结果21例(10.2%)绝经后子宫内膜癌患者EEC≤4 mm,其中Ⅰ型1例(4.8%),Ⅱ型20例(95.2%),差异有统计学意义(P<0.001)。0.9%Ⅰ型和25.0%Ⅱ型子宫内膜癌患者存在绝经后阴道流血症状且EEC≤4 mm,两者差异有统计学意义(P<0.001)。Ⅱ型子宫内膜癌中,EEC≥5 mm 56例,≤4 mm 20例,显示不清8例。20例EEC≤4 mm患者中发现≥1项异常超声表现:4例(20.0%)宫腔积液,5例(25.0%)宫腔占位病变,8例(40.0%)子宫肌层占位病变,14例(70.0%)子宫增大,2例(10.0%)附件区占位病变。结论子宫内膜线薄,特别是合并绝经后阴道流血症状时不能完全排除Ⅱ型子宫内膜癌的可能性,应刮宫或宫腔镜检查并行子宫内膜组织病理学检查。     

绝经后子宫内膜组织学变化

1　绝经后的子宫内膜围绝经期卵巢功能开始衰减 ,绝经后则更进一步衰退 ,雌激素分泌低下 ,内膜萎缩。此种萎缩的内膜一般呈单纯萎缩和囊性萎缩两种组织学形态。两种不同形态的萎缩内膜可能与绝经前的末次月经周期有无排卵有关。绝经前的末次月经如有排卵 ,绝经后内膜往往呈单纯萎缩 ;如末次月经系无排卵月经 ,内膜多为不规则增生或简单型增生过长 ,则绝经后腺体大小不一的形态可被保留 ,而形成囊性萎缩。有时内膜腺体开口被堵塞 ,也可致个别腺腔扩大[1] 。1 1　单纯萎缩 (ｓｉｍｐｌｅａｔｒｏｐｈｙ)　内膜很薄 ,功能层与基底层界限不清 ;…     

绝经后妇女阴道超声与子宫内膜病变的相关性

阴道超声测量子宫内膜厚度对预测绝经后妇女子宫内膜的病理变化有重要的价值。正常萎缩的子宫内膜很薄,声像法测量为２～３ｍｍ。在未接受雌激素替代疗法的妇女中,超声检查子宫内膜〈５ｍｍ,无行诊刮术必要。子宫内膜≥５ｍｍ应作诊刮术,进一步病理检查明确诊断。绝经后妇女采用雌激素替代治疗,建议子宫内膜〈８ｍｍ为阈值界限,在无症状的妇女中不需作进一步检查。阴道超声测量子宫内膜厚度可作为绝经后妇女子宫内膜病理变化的     

Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium: data from the FAME-Endo study: an observational register study

Purpose

To evaluate the risk for endometrial cancer (EC) in a large series of asymptomatic patients with thickened endometrium at ultrasound examination based on previously published data of a theoretical cohort.

Methods

In a prospective register study, a total of 1024 women with thickened endometrium in ultrasound examination undergoing histological diagnosis by dilation, hysteroscopy and curettage were evaluated. 124 patients were excluded due to current medication with tamoxifen and/or presence of HNPCC leaving 900 patients for further analysis.

Results

Mean [standard deviation (SD)] age of patients was 65.6 (8.6) years. Mean (SD) endometrial thickness was 11.9 (5.8) mm. 32 and 6 cases of EC and complex endometrial hyperplasia with atypia were found, respectively. In the univariate analysis, a statistically significant association between endometrial thickness, current use of antihypertensive medication, number of deliveries, and the presence of endometrial fluid in preoperative vaginal ultrasound (p?<?0.05) with EC was found. A multivariate logistic regression model incorporating these parameters showed a statistically significant independent association of endometrial thickness, number of deliveries, and the presence of endometrial fluid in preoperative vaginal ultrasound (p?<?0.05), but not current use of antihypertensive medication, with EC. Using a cut-off of the endometrial thickness of?>?11 mm, the risk for “EC alone” and “EC and complex endometrial hyperplasia with atypia combined” was found to be 6.7% and 7.9%, respectively.

Conclusions

Our data compare favorably to a theoretical cohort suggesting a clinically reasonable cut-off of?>?11 mm endometrial thickness to discriminate between “normal” and “pathological”. The data regarding “risk for endometrial cancer” can be used for counseling affected women.

     

Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium

Objectives  

The goal of this study was to define the diagnostic value of hysteroscopy in evaluating uterine cavity compared to endometrial biopsy in women presenting with postmenopausal bleeding and thick endometrial mucosa with particular attention to endometrial hyperplasia and carcinoma.     

Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography.

OBJECTIVE: To evaluate endometrial thickness and uterine arterial flow measurement as predictors of endometrial cancer. DESIGN: Prospective study among a cohort of women invited to age-adjusted, population-based breast cancer screening by mammography. SETTING: City of Turku, Finland. POPULATION: 1074 postmenopausal women aged 57-61 years (mean 59 years). METHODS: Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was > or = 4.0 mm, if the uterine artery pulsatility index was < or = 1.0 or if there was a fluid accumulation in the endometrial cavity. MAIN OUTCOME MEASURES: Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models. RESULTS: An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result. CONCLUSION: Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is > or = 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.