孕激素刺激试验和经阴道超声检查在绝经后妇女子宫内膜病变筛查中的作用

PROGESTERONE CHALLENGE TEST AND TRANSVAGINAL ULTRASONOGRAPHY IN THE DETECTION OF ENDOMETRIAL PATHOLOGY IN POSTMENOPAUSAL WOMEN

①目的 探讨孕激素刺激试验和经阴道超声检查在绝经后妇女子宫内膜病变筛查中的作用。②方法 对 10 6例无症状的绝经后妇女行阴道超声检查 ,测定其矢状面下子宫内膜前后径最大厚度 (双层 )及其形态 ,超声检查后行孕激素刺激试验及诊断性刮宫。③结果 11例妇女孕激素刺激试验阳性 ,其中 9例为异常子宫内膜。孕激素刺激试验用于检测子宫内膜疾病的灵敏度、特异度、阳性预测值、阴性预测值分别为 81.8%、97.9%、81.8%、97.9%。 2 9例妇女子宫内膜厚度≥ 5mm ,其中 10例为异常子宫内膜。以 5mm为分界点 ,阴道超声用于检测子宫内膜疾病的灵敏度、特异度、阳性预测值、阴性预测值分别为 90 .9%、77.9%、32 .3%、98.7%。对于子宫内膜厚度≥ 5mm者加用孕激素刺激试验 ,特异度将提高至 90 .5 %。④结论 孕激素刺激试验联合经阴道超声检查是简单、安全、可靠、易被接受的绝经后无症状妇女子宫内膜病变的筛查方法。

Objective To evaluate the effect of progesterone challenge test(PCT) and transvaginal ultrasonography(TVUS) in screening of postmenopausal asymptomatic women for the detection of endometrial pathology. Methods The TVUS was done for 106 postmenopausal asymptomatic women. The maximal endometrial thickness under the sagittal plane was measured, and the morphology was observed. All women underwent PCT and diagnostic curettage following TVS. Results Eleven cases showed a positive PCT, of which, nine had abnormal endometrium. The sensitivity, specificity, positive predictive value, and negative predictive value of PCT to detect endometrial diseases were 81.8%, 97.9%, 81.8%, and 97.9%, respectively. Twenty-nine women had endometrial thickness ≥5 mm, ten of whom had abnormal endometrium. The sensitivity, specificity, positive predictive value, and negative predictive value of TVUS for detecting endometrial diseases were 90.9%, 77.9%,32.3%, and 98.7% , respectively. The specificity was improved to 90.5% with the combination of TVUS and PCT for the women with endometrium ≥5 mm. Conclusion TVUS with PCT is a simple, well-tolerated, safe and reliable method for screening endometrial cancer in postmenopausal women.