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

Diagnostic significance of the thickness of endometrial echo complex in postmenopausal women with type 2 endometrial cancer

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。

Objective To determine the diagnostic significance of the thickness of the endomctrial echo complex （EEC） in postmenopausal patients with type 2 endometrial cancer （EC）. Methods Postmenopausal patients with EC who underwent preoperative ultrasound from 2010 to 2015 were identified from our institutional database.Histologic diagnoses were made by biopsy or hysterectomy.Ultrasound reports were abstracted for the following parameters： EEC thickness, presence of intracavitary fluid or lesion, myometrial mass, uterine size, and adnexal mass.Differences between type 1 and type 2 ECs were determined. Results Among 205 patients with postmenopausal EC, 121 had type 1 EC while 84 had type 2 EC.About 10.2% of the cohort had an EEC ~〈4 mm, including 4.8% of patients with type 1 EC and 95.2% of patients with type 2 EC （P〈0.001）.When limited only to patients with postmenopausal bleeding, 0.9% with type 1 EC and 25.0% with type 2 EC had an EEC ≤4 mm （P〈0.001）. Totally 56 patients with type 2 EC had a thickened EEC measuring i〉5 mm.In 20 cases, the EEC was≤4 mm.In an additional 8 patients the EEC was indistinct.One or more other uhrasound abnormalities were found in each of the 20 cases with a non-thickened EEC： intracavitary fluid （4,20.0%）, intracavitary lesion （5,25.0%）, myometrial mass （15,70.0%）, enlarged uterus （14,70%）, or adnexal mass （2,10.0%）. Conclusion A thin endometrial stripe, especially when associated with postmenopausal vaginal bleeding, does not reliably exclude type 2 EC, and histologic evaluation should be per- formed.