Ultrasound assessment of the endometrium in healthy, asymptomatic early post-menopausal women: saline infusion sonohysterography versus transvaginal ultrasound.

OBJECTIVE: To exclude pre-existing endometrial pathology in asymptomatic early post-menopausal women before starting hormone replacement therapy by transvaginal ultrasound (TVS) and saline infusion sonohysterography (SIS). METHODS: In a cross-sectional study, 148 healthy women (mean age, 51.1 years; range, 46-59 years) underwent ultrasound evaluation of the endometrium before participation in a clinical trial. TVS was used to measure double-layer endometrial thickness. SIS was performed at the same visit to measure anterior and posterior single-layer endometrial thickness, and to identify endometrial abnormalities when present. Ultrasound results were defined as informative if the endometrium could be adequately visualized. Findings on TVSs were defined as abnormal if a double-layer endometrial measurement > 5.0 mm was obtained. Findings on SIS were defined as abnormal if one or both single layers of the endometrium measured > 2.5 mm, or if focal endometrial thickening or a polyp was present. RESULTS: Of the 148 eligible women, informative TVS results were obtained from 134 women, SIS results from 133 women and both procedures combined from 119 women. TVS scans gave abnormal results in 8.2% of women (11 of 134) and SIS gave abnormal results in 36.8% of women (49 of 133). Of the 14 women with a non-informative TVS, eight had abnormal SIS results. Of the 15 women with a non-informative SIS, three had abnormal TVS results. In the 119 women with both informative TVS and SIS, abnormal TVS scans were found in 6.7% of women (eight of 119) and abnormal SIS in 34.5% of women (41 of 119). All eight women with abnormal TVS had an abnormal SIS, whereas 29.7% (33 of 111) of the women with a normal TVS had an abnormal SIS. CONCLUSIONS: Ultrasound evaluation demonstrated endometrial abnormalities in 34.5% (41 of 119) of asymptomatic post-menopausal women. SIS is more accurate than TVS in the detection of endometrial abnormalities.     

经阴道彩色多普勒超声对绝经后子宫出血疾病的诊断价值

目的　评价经阴道彩色多普勒超声（ＴＶＳ）对绝经后子宫出血妇女内膜疾病的诊断价值以及对子宫内膜癌肌层浸润的估测。方法　对１１１例绝经后子宫出血妇女进行ＴＶＳ检查, 观察其内膜厚度、内膜回声结构及血流。结果　ＴＶＳ测量内膜厚度＜ ５ｍ ｍ 时可不做诊刮, 定期进行观察; 内膜癌和良性病变的血流显示率及动脉ＲＩ值有显著性差异（Ｐ＜ ０．０５）; ＴＶＳ能较精确地判断内膜癌的肌层浸润, 与病理结果有极显著相关性（ｒ＝ ０．９８,Ｐ＜ ０．００１）。结论　ＴＶＳ可作为绝经后子宫出血患者的首选检查方法     

Transvaginal sonography in postmenopausal women

Transvaginal sonography (TVS) is a recent addition to the diagnostic techniques available for the evaluation of the female pelvis. Our experience in over 200 cases of postmenopausal women is the subject of this synoptic review. Using this technique in 60 women, we were able to detect endometrial changes such as endometrial carcinoma or adenomatous hyperplasia in 81% and in a group of 19 patients myometrial invasion in 84%. Fibroids of different sizes and locations could be recognized, some of them with signs of cystic degenerations. In 48 postmenopausal women, TVS was used to follow the morphologic changes in the endometrium stimulated by hormone replacement therapy. Histological features of the endometrium were in close correlation with the sonographic patterns obtained. Ultrasound evaluation has been suggested as a possible screening tool for early changes in ovarian size and morphology. Fifty patients were evaluated for the effectiveness of TVS to detect ovarian pathology. The sensitivity and specificity were 83% and 100%, the same as that of gross examination of the ovary at the time of surgery. It seems that TVS is a reliable tool in the detection of early changes in the postmenopausal ovary, but further evaluation in a large population is necessary to assess the usefulness of TVS as a routine screening tool for early ovarian carcinoma. Twenty-nine postmenopausal women with unilateral simple cysts (diameter less than or equal to 5 cm) were identified. All exhibited benign histopathologic changes. We conclude that small (less than 5 cm) postmenopausal cysts have a low incidence of malignancy and could be followed by TVS without immediate surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study.

OBJECTIVES: The aim of this study was to assess if endometrial thickness could be used to select postmenopausal women on hormonal replacement therapy (HRT) at increased risk for endometrial abnormalities. The secondary aim was to assess if endometrial abnormalities were more likely to occur in patients with increased endometrial thickness or in patients with unexpected bleeding. METHODS: Bi-endometrial thickness was measured by transvaginal ultrasound (TVS) in postmenopausal patients on sequential or combined HRT regimens. Women following a sequential regimen underwent TVS examination immediately after their withdrawal bleed, always between 5 and 10 days after the last progesterone tablet. A hysteroscopy with endometrial biopsy was performed within 5 days after the TVS examination, when endometrial thickness was > or = 4 mm, or when unscheduled bleeding was observed. RESULTS: A total of 190 women were recruited. In 138 women on sequential regimens, the mean value of endometrial thickness was 3.6 mm +/- 1.5, and in 52 women on combined regimens it was 3.2 mm +/- 1.8 (P = n.s.) Twenty-eight patients (15%) had an endometrial thickness > 4 mm, 35 patients (18.4%) reported unexpected bleeding. The percentage of abnormal endometrial findings (9%; three of 35) in patients selected for unscheduled bleeding was significantly lower than the percentage of abnormal findings in patients selected for hysteroscopy for endometrial thickness > 4 mm (36%; 10 of 28) (P < 0.01). All patients with unexpected bleeding and endometrial thickness < or = 4 mm (24 cases) were found to have an atrophic endometrium. CONCLUSIONS: Endometrial thickness in patients on sequential HRT, measured soon after withdrawal bleeding, is not significantly different from thickness measured in patients on combined HRT. Patients on HRT with an endometrial thickness of > 4 mm could be considered for histological sampling. The prevalence of abnormal endometrial findings in patients with a thick endometrium is significantly higher than the prevalence observed in patients with unexpected bleeding.     

经阴道超声与宫腔镜检查诊断绝经后服用他莫昔芬妇女子宫内膜病变的比较

目的 该研究比较了经阴道超声（transvaginal ultrasonography,TVS）与宫腔镜检查（hysteroscopy,HS）在诊断绝经后服用他莫昔芬（tamoxifen,TAM）对子宫内膜病变的价值,以探讨与其相关的监测方法.方法 随诊了46例绝经后因乳腺癌服用TAM（20mg/d）超过6个月的妇女.所有患者均施行了TVS、HS以及内膜组织病理学检查.TVS以子宫内膜厚度≥5mm为阳性判断标准.结果 TVS检查结果阳性21例（45.7%）中,经HS及病理诊断证实内膜息肉14例,单纯增殖型内膜2例,萎缩型内膜5例;TVS检查结果阴性25例（54.3%）中,内膜息肉8例,单纯增殖型内膜3例,萎缩型内膜14例.TVS检查的特异性为70.8%,敏感性为63.6%,阳性预测值为66.7%,阴性预测值为68.0%.而HS分别为100%、96.0%、95.7%和95.7%.息肉病人的TVS结果与非息肉病人比较差异有显著性（P=0.019）.结论 由于TAM对绝经后的子宫内膜具有雌激素样作用,能够引起内膜基质水肿,产生类似增生内膜的超声影像,导致TVS的检查结果与HS下所见以及内膜病检不相符.服用TAM的绝经后乳腺癌患者,单纯以TVS作为其内膜病变的筛选方法具有一定诊断价值,但存在较高的假阳性率且特异性较差.在确诊子宫内膜息肉方面HS具有特殊优势.     

Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women.

OBJECTIVE: To compare the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) for detecting intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHOD: Consecutive premenopausal women who underwent hysterectomy for abnormal uterine bleeding were included. All women underwent TVS and SIS before their hysterectomy. The findings at TVS and SIS were compared with the findings of the hysterectomy specimen. Sensitivity, specificity, and likelihood ratios were calculated. RESULTS: The results of 50 patients with abnormal uterine bleeding were evaluated. Histological examination revealed normal endometrial histology in 27 patients, submucous myomas in 13 patients and intracavitary polyps in 10 patients. The sensitivity of TVS in directly visualizing intracavitary abnormalities was 61% for a specificity of 96%. The likelihood ratio of presence of an intracavitary abnormality was 16 and the likelihood ratio of absence of such a finding was 0.41. When defining abnormality at TVS as direct visualization of an intracavitary abnormality or an increased endometrial thickness (cut-off level 5 mm), the sensitivity of TVS was 87% for a specificity of 56%, with corresponding likelihood ratios of 2 and 0.23, respectively. The sensitivity and specificity of SIS was 100% and 85% with likelihood ratios of 6 and 0.0, respectively. No intracavitary abnormality was missed by SIS. CONCLUSION: The diagnostic accuracy of SIS is higher than the accuracy of TVS. A combined approach using endometrial thickness measurement by TVS and, reserving SIS for patients with increased (> 5 mm) endometrial thickness, or endometrium inadequately visualized on TVS, is the optimal method of reducing the hysteroscopy rate.     

Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler.

Our objective was to find the prevalence of non-symptomatic endometrial and ovarian neoplasms in a volunteer population of women, aged 40 and over. We offered a free volunteer screening program to asymptomatic women for a study using transvaginal ultrasound and color flow Doppler for the detection of pelvic cancer. In the first 2 years, 2117 women were examined, 51.3% post-menopausal. An ovarian cyst was defined as having a maximum diameter of more than 2.4 cm. Color flow was used to identify blood vessels feeding pelvic organs and adnexal enlargements. An abnormal Doppler flow velocity for the ovary was defined as a resistance index of less than 0.41. Ovarian cysts of less than 5 cm with normal Doppler indices were followed up in 6 months to 1 year. An adnexal morphology score was created to quantify the usefulness of this parameter, particularly in postmenopausal women. Indications for surgery were pre-defined as a persistent ovarian cyst of more than 5 cm, a persistent suspicious Doppler and a total endometrial thickness of greater than 0.59 cm in postmenopausal women not taking hormones.A total of 202 women (9.5%) had ovarian cysts. Fourteen women were operated upon because of size criteria, one because of family history and three for persistent abnormal flow. By Doppler study, 15 cysts were predicted to be benign and histology was confirmatory. There were two false positives and one true positive, a stage Ib ovarian cancer. There were no false negatives, although a stage I endometrioid cancer of the ovary was detected 8 months after a negative scan. In those cases in which follow-up data were available, 56% of the cysts regressed in premenopausal women. In postmenopausal women, 28% regressed. Twenty of 1086 postmenopausal women had endometrial biopsies. Three had endometrial cancer, two stage I and one stage IIA. Five had atypical or adenomatous hyperplasia, and seven had benign polyps.So many women have small asymptomatic cysts of the ovary that a major reorientation of physicians' attitudes towards the ovary will have to be introduced to adapt to this new information. In this population, the prevalence of benign epithelial ovarian neoplasms was 7/1000, and of malignancy was 05/1000. In postmenopausal women, the prevalence rate for endometrial cancer was 5/1000, with 5/1000 hyperplasias and 7/1000 benign polyps. When endometrial and ovarian cancer screening are combined, the yield is comparable to that seen in breast and cervical cancer screening.     

经阴道超声测量对绝经后子宫内膜癌的诊断价值

目的:评价经阴道超声测量对绝经后子宫内膜癌的诊断价值。方法:选择因经阴道超声提示宫腔占位行宫腔镜检查术绝经后妇女520例,分析绝经后子宫内膜癌患者的相关特征。以病理诊断结果为金标准,评价经阴道超声和宫腔镜诊断子宫内膜癌的灵敏度和特异度。以ROC曲线下面积确定经阴道超声测量宫腔占位大小诊断绝经后子宫内膜癌的最佳临界值。结果:绝经后阴道流血(postmenopausal bleeding,PMB)、宫腔占位大及宫腔积液多与绝经后子宫内膜癌相关,而年龄、绝经年龄、绝经时间、内膜厚度与绝经后子宫内膜癌无关。伴PMB妇女的子宫内膜癌发生率是无PMB妇女的6.4倍。宫腔镜诊断绝经后子宫内膜癌的准确性高于经阴道超声。超声测量宫腔占位大小诊断无PMB子宫内膜癌的最佳临界值为14.5mm,此时阳性预测值为10.75%、阴性预测值为99.14%。超声测量宫腔占位大小诊断伴PMB绝经后子宫内膜癌的最佳临界值为18.5mm,此时阳性预测值为55.56%、阴性预测值为91.94%。结论:对于无PMB的妇女,经阴道超声测量宫腔占位大于14.5mm作为行宫腔镜检查的指征较合理;而对于经阴道超声发现宫腔占位且伴PMB的妇女,子宫内膜癌发生率较高,建议均行宫腔镜检查。     

Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding

PURPOSE: Saline infusion sonography (SIS) is a relatively new technique in the evaluation of abnormal uterine bleeding. We compared the diagnostic accuracy of SIS with that of transvaginal sonography (TVS) in the detection of intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHODS: In this prospective study, consecutive premenopausal women who underwent a hysteroscopy for abnormal uterine bleeding also underwent TVS and SIS. The findings at TVS and SIS were compared with the hysteroscopic and histologic findings. Sensitivity, specificity, and likelihood ratios were calculated. Receiver operating characteristic curves were constructed to assess the performance of endometrial thickness measured using TVS. RESULTS: Sixty-two patients were included in the study. TVS demonstrated 60% sensitivity in directly visualizing intracavitary abnormalities and 93% specificity. The likelihood ratio of the presence of an intracavitary abnormality was 8, and the likelihood ratio of the absence of an intracavitary abnormality was 0.43. Defining an abnormality at TVS as direct visualization of an intracavitary abnormality or an endometrial thickness greater than 5 mm, TVS had an 85% sensitivity and a 21% specificity, with corresponding likelihood ratios of 1.1 and 0.71, respectively. For SIS, the sensitivity, specificity, and likelihood ratios of the presence and absence of intracavitary abnormalities were 88%, 95%, 10, and 0.13, respectively. CONCLUSIONS: SIS is more accurate in the diagnosis of intracavitary abnormalities in premenopausal women than is TVS. An approach using endometrial thickness measurement by TVS and reserving SIS for patients who have an endometrial thickness greater than 5 mm or an intracavitary abnormality visualized by TVS would be the most effective method to reduce the number of hysteroscopies.     

经阴道超声结合宫腔镜检查对绝经后子宫出血的诊断价值

目的探讨经阴道超声(TVS)结合宫腔镜(HSC)检查在绝经后子宫出血中的诊断价值。方法回顾性分析2007年6月至2010年6月应用TVS结合HSC检查绝经后子宫出血230例,术中行定位取材或诊断性刮宫。结果 TVS诊断绝经后子宫出血病人宫腔内病变的符合率为71.74%,TVS结合HSC的诊断符合率为88.26%。结论 TVS结合HSC对发现绝经后子宫出血病人宫腔内病变具有一定的价值。     

Transvaginal color and pulsed Doppler sonography of the endometrium: a possible role in reducing the number of dilatation and curettage procedures.

The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospective study involved 42 postmenopausal patients who were examined, prior to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vaginal bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cut-off value of 8 mm), rates of visualization, and the density of uterine, myometrial (peritumoral) and endometrial (intratumoral) vessels were used, along with pulsatility and resistive indices of these vessels, to assess and correlate with endometrium pathology. Endometrial thickness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in asymptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vessels in cases of endometrial carcinoma was 93% and 43% respectively, which was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carcinoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularity was found in the myometrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

宫腔声学造影诊断子宫内膜息肉的价值

目的：评价宫腔声学造影（SHG）对子宫内膜息肉的诊断价值。方法：对临床拟诊宫内膜息肉的76例患者进行TVS、SHG及官腔镜手术-病理检查,并对结果进行分析。结果：以手术病理结果作为诊断金标准,内膜息肉48例,黏膜下肌瘤9例,内膜增生10例,官腔内机化血凝块3例,正常内膜6例。SHG对子宫内膜息肉诊断的准确性为93．4％,敏感性为93．7％,特异性为92．8％。TVS对子宫内膜息肉诊断的准确性为59．2％,敏感性为81．2％,特异性为21．4％。两种方法对内膜息肉的诊断准确率比较有显著差异（χ^2=5．45,P=0．019）。结论：官腔声学造影准确率高,是诊断子宫内膜息肉的可靠方法。     

How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding.

OBJECTIVE: Transvaginal sonography (TVS) is routinely performed as part of a pelvic sonogram in postmenopausal women, and images of the endometrium are frequently obtained. In women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known. The aim of this study was to determine an endometrial thickness threshold that should prompt biopsy in a postmenopausal woman without vaginal bleeding. METHODS: This was a theoretical cohort of postmenopausal women aged 50 years and older who were not receiving hormone therapy. We determined the risk of cancer for a postmenopausal woman with vaginal bleeding when the endometrial thickness measures > 5 mm, and then determined the endometrial thickness in a woman without vaginal bleeding that would be associated with the same risk of cancer. We used published and unpublished data to determine the sensitivity and specificity of TVS, the incidence of endometrial cancer, the percentage of women symptomatic with vaginal bleeding, and the percentage of cancer that occurs in women without vaginal bleeding. Ranges for each estimate were included in a sensitivity analysis to determine the impact of each estimate on the overall results. RESULTS: In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and < 0.07% if her endometrium is thin (< or = 5 mm). An 11-mm threshold yields a similar separation between those who are at high risk and those who are at low risk for endometrial cancer. In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is thick (> 11 mm) and 0.002% if the endometrium is thin (< or = 11 mm). The estimated risk of cancer was sensitive to the percentage of cancer cases that were estimated to occur in women without vaginal bleeding. For the base case we estimated that 15% of cancers occur in women without vaginal bleeding. When we changed the estimate to project that only 5% of cancers occur in women without vaginal bleeding, the projected risk of cancer with a thick measurement was only 2.2%, whereas when we estimated that 20% of endometrial cancers occur in women without bleeding, the projected risk of cancer with a thick measurement was 8.9%. As a woman's age increases, her risk of cancer increases at each endometrial thickness measurement. For example, using the 11 mm threshold, the risk of cancer associated with a thick endometrium increases from 4.1% at age 50 years to 9.3% at age 79 years. Varying the other estimates used in the decision analysis within plausible ranges had no substantial effect on the results. CONCLUSIONS: In a postmenopausal woman without vaginal bleeding, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures < or = 11 mm a biopsy is not needed as the risk of cancer is extremely low.     

Transvaginal hysterosonography in the evaluation of small endoluminal masses.

Transvaginal sonography is highly sensitive for detecting endometrial mass lesions, but it is nonspecific. Biopsies performed on patients with abnormal findings seen on TVS often are negative. We performed transvaginal hysterosonography prospectively on 48 consecutive patients with endometrial thickness demonstrated on TVS to be between 5 and 10 mm to assess whether this technique would be useful in the evaluation of such patients. TVHS is a simple, painless technique that is performed by placing a small catheter into the endometrial canal and infusing a small amount of saline solution under sonographic visualization. Of 48 suspected lesions, TVHS confirmed only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to be homogeneously echogenic and to have a pedunculated attachment to the uterine wall without interruption of the endometrial lining. Fibroids showed more heterogeneous echogenicity and had a more sessile attachment. Four patients in our series had false-negative biopsy results prior to having had endometrial mass lesions depicted on TVHS. TVHS may prevent unnecessary biopsies in those patients who appear to have abnormalities on TVS. By depicting the nature of the attachment of endoluminal masses to the uterine wall more clearly, TVHS also may help direct subsequent biopsy procedures.     

Use of vaginosonographic measurements of endometrial thickness in the identification of abnormal endometrium in peri- and postmenopausal bleeding

One hundred and seventy seven women with peri- and postmenopausal bleeding were subjected to vaginosonographic examination followed by thorough pathological examination of the uterine curetting samples. A mean endometrial thickness (double layer) of 13.2 ± 3.6 mm and 8.2 ± 4.8 mm were found in those with and without histological abnormalities, respectively. Endometrial thickness of less than 7 mm, however, was found to be predictive of normal endometrium (100% sensitivity, 46% specificity) and can, therefore, be used to separate those who require diagnostic curettage from those who do not. These findings suggest that this relatively simple, noninvasive procedure can be used as a screening test for patients with peri- or postmenopausal bleeding. © 1994 John Wiley & Sons, Inc.     

Postmenopausal bleeding should be referred urgently

Postmenopausal bleeding is an episode of bleeding 12 months or more after the last menstrual period. It occurs in up to 10% of women aged over 55 years. All women with postmenopausal bleeding should be referred urgently. Endometrial cancer is present in around 10% of patients; most bleeding has a benign cause. The peak incidence for endometrial carcinoma is between 65 and 75 years of age. Causes of postmenopausal bleeding include: endometrial carcinoma; cervical carcinoma; vaginal atrophy; endometrial hyperplasia +/- polyp; cervical polyps; hormone-producing ovarian tumours; haematuria and rectal bleeding. The aim of assessment and investigation of postmenopausal bleeding is to identify a cause and exclude cancer. Assessment should start by taking a detailed history, with identification of risk factors for endometrial cancer, as well as a medication history covering use of HRT, tamoxifen and anticoagulants. Abdominal and pelvic examinations should be carried out to look for masses. Speculum examination should be performed to see if a source of bleeding can be identified, assess atrophic changes in the vagina and look for evidence of cervical malignancy or polyps. Ultrasound scan and endometrial biopsy are complementary. Ultrasound scan can define endometrial thickness and identify structural abnormalities of the uterus, endometrium and ovaries. Endometrial biopsy provides a histological diagnosis. The measurement of endometrial thickness aims to identify which women with postmenopausal bleeding are at significant risk of endometrial cancer. If the examination is normal, the bleeding has stopped and the endometrial thickness is < 5 mm on transvaginal ultrasound scan, no further action need be taken.     

绝经后妇女腔内超声特点

目的通过腔内超声建立绝经后妇女正常子宫与卵巢体积的数值及形态图像,以便筛查异常子宫病变与异常卵巢体积与卵巢肿瘤.方法经阴道对绝经后3026例妇女进行TVS检查,测量子宫、卵巢的长、宽、厚三径.结果按具体公式计算出萎缩子宫三径之和＜11cm,卵巢体积应＜10cm3或8.8ml.结论经TVS检查是测量子宫与卵巢体积与形态的最佳方法,是筛查绝经后子宫病变与卵巢癌的首选方法.     

Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium

BACKGROUNDPostmenopausal bleeding and an endometrial thickness ≥ 5 mm on sonograms of menopausal women can indicate the presence of endometrial lesions. Diagnostic hysteroscopy is a powerful method for endometrial diseases.AIMTo investigate the pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or asymptomatic thickened endometrium diagnosed by hysteroscopy.METHODSA total of 187 postmenopausal women with bleeding or asymptomatic thickened endometrium underwent diagnostic hysteroscopy. The women were subsequently divided into three groups: Postmenopausal bleeding (PMB) group (n = 84), asymptomatic group (n = 94), and additional group (n = 9). Women in the additional group manifested abdominal pain and leukorrhagia.RESULTSAmong the 187 patients examined, 84 (44.9%) were diagnosed with PMB and 94 (50.3%) with asymptomatic thickened endometrium. Endometrial polyp was the most common endometrial abnormality, which was detected in 51.2%, 76.6% and 77.8% of the PMB, asymptomatic, and additional groups, respectively. In the PMB group, 7 (8.3%) women had hyperplasia with atypia and 14 (16.7%) had endometrial adenocarcinoma. Fewer malignant lesions were detected in the asymptomatic group. Endometrial hyperplasia without atypia was found in 8.3% of the PMB group and 7.4% of the asymptomatic group.CONCLUSIONEndometrial polyp was the most common pathology in the PMB group. Diagnostic hysteroscopy is recommended for women with PMB and asymptomatic thickened endometrium.     

绝经后宫腔积液105例临床分析

目的探讨绝经后宫腔积液的病因及诊治方法。方法对105例绝经后阴道B型超声（TVS）检查所示宫腔积液的患者进行回顾性分析。结果 105例患者中,阴道炎患者31例,占29.52%;其余74例患者行宫腔镜检查显示,宫腔点状出血29例,占27.62%,宫腔透明粘液23例,占21.90%,另有22例宫腔镜下未见异常,占20.95%。74例接受宫腔镜检查患者因诊刮未刮出内膜组织,行宫腔细胞学涂片,病理检查结果均未见恶性肿瘤细胞,其中16例患者查见炎性细胞。结论绝经后无子宫内膜增厚的宫腔积液多由炎症引起,应及早明确诊断。宫腔镜现已成为宫腔内病变诊断的金标准,其作为绝经后宫腔积液的病因诊断手段具有临床实用价值。