摘要
目的比较经阴道超声(TVS)、宫腔镜和子宫内膜活检在绝经后阴道出血患者诊断中的作用,为绝经后阴道出血患者早期发现子宫内膜癌找到最适合的诊断方法。方法通过回顾性分析我院2005年1月至2006年12月收治的300例绝经后阴道出血的患者的临床资料,分别计算TVS、宫腔镜和诊断性刮宫取内膜活检诊断子宫内膜癌的灵敏度、特异度、阳性预测值、阴性预测值及ROC曲线下面积,并比较三者对子宫内膜癌的诊断价值。结果在TVS检测子宫内膜<4 mm中,经组织病理学确诊1例(1/19)为子宫内膜癌。在子宫内膜≥4mm中,术后经组织病理学确诊26例(26/281)为子宫内膜癌。如果以子宫内膜≥4mm为临界值,TVS的灵敏度和特异度分别为96.15%和6.57%,阳性预测值8.90%,阴性预测值94.73%(ROC曲线下面积:0.726)。以子宫切除术后病理诊断为黄金标准,宫腔镜的灵敏度和特异度分别为100%和98.54%,阳性预测值86.67%,阴性预测值100%(ROC曲线下面积:0.982);内膜活检的灵敏度和特异度分别为96.3%和100%,阳性预测值100%,阴性预测值99.0%(ROC曲线下面积:0.999)。结论TVS以4 mm为临界值对绝经后阴道出血患者诊断内膜癌的灵敏度较高,但对于子宫内膜厚度<4 mm的,可能会漏诊子宫内膜癌。对于绝经后阴道出血的患者都应该进行宫腔镜检查和内膜诊刮。
Objective To compare accuracy of transvaginal ultrasound （TVS） in measuring endometrial thickness and accuracy of hysteroscopy and endometrial curettage in diagnosing endometrial carcinoma in an attempt to find an optimal bay of detecting endometrial carcinoma early in poslmenopausal women who had abnormal vaginal bleeding. Methods This retrospective study was conducted 300 consecutive postmenopausal patients with abnormal uterine hleeding, who under,vent trangvaginal ultrasound evaluation of endmnetrial thickness, hysteroscopy and endometrial curettage.Sensitivity, specificity, positive and negative predictive values were performed and a receiver operator characteristic curve（ROC） was calculated. Results Of 19 endometrinm 〈4 mm cases as measured by TVS, one case of endometrial carcinoma was confirmed by histolopathology, and of 281 endometrium ≥ 4 mm cases, 26 cases of endometrial carcinoma were confirmed by histolopathology. Given endometrial thickness ≥4 mm as the critical value, the sensibility and specificity of TVS was 96.3% and 6.6% respectively, and the positive predictive value was 9.3% and the negative predictive value was 94.7% （ROC crate： 0.726 ）. Hysteroscopy revealed sensitivity 100%, specificity 98.9%, positive predictive value 90.0% and negative predictive value 100% according to histologic findings of snrgical specimens underwent hysterectomy（ROC curve： 0.982） .As well, endometrial hiopsy revealed sensitivity were 96.3%, specificity 100%, positive predictive value 100% and negative predictive value 99% （ROC curve 0.999）. Conclusions Trans-vaginal ultrasound is the first line diagnostic procedure in postmenopausal women with abnormal uterine bleeding. Though there is a high sensibility with a cut-off value ≥ 4 mm ,but endometrial thickness 〈4mm can miss malignancies. Hysteroscopy with endometrial curettage is mandatory in all postmenopausal women with abnormal uterine bleeding.
出处
《老年医学与保健》
CAS
2007年第2期95-97,共3页
Geriatrics & Health Care
