经阴道超声测量对绝经后子宫内膜癌的诊断价值

Diagnostic value of transvaginal ultrasonographic measurement of polypoid mass in uterine cavity in identifying postmenopausal endometrial cancer

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。

Objective ： T o evaluate the value of transvaginal ultrasonographic （T V S ） measurement of polypoid mass inuterine cavity in identifying postmenopausal endometrial cancer. Methods： Totally 520 postmenopausal women acceptedhysteroscopy（H y） for polypoid mass in uterine cavity by T V S . Characteristics of postmenopausal women with endometrialcancer were analyzed. T h e sensitivity and specificity of T V S and Hy diagnosing endometrial cancer were calculated with thehistological results being the gold standard. T h e best cut-off point of the size of polypoid mass by T V S diagnosing endometrialcancer was determined by RO C curve. T h e positive predictive value （P P V ） and the negative predictive value （N P V ） of the bestcut-off point were calculated. Results： T h e postmenopausal endometrial cancer was correlated with postmenopausal bleeding（ P M B ） , larger polypoid m ass, and more uterine hydrops, but not with age, age at menopausal, years of menopausal orthickness of endometrium. T h e prevalence of postmenopausal endometrial cancer with PM B was 6. 4 times higher than thoseswithout PMB. T h e accuracy of H y diagnosing postmenopausal endometrial cancer was higher than that of T V S . T h e best cutoffpoint of the size of polypoid mass by T V S diagnosing endometrial cancer in asymptom postmenopausal women was14. 5 mm, with the P P V 10. 7 5 % and the N PV 99. 14% . T h e best cut-off point of the size of polypoid mass by T V S diagnosingendometrial cancer in PM B postmenopausal women was 18. 5 mm, with the P P V 55. 56% and the N PV 91. 94% . Conclusions：For asymptom PM B postmenopausal women, the size of polypoid mass in uterine cavity by T V S over 14. 5 mm as indication ofHy is reasonable. T h e prevalence of endometrial cancer is high in PM B postmenopausal women with polypoid mass found byT V S , thus Hy should be provided.