经阴道超声检查用于协助诊断糖尿病或肥胖妇女绝经后阴道出血的准确性  

Accuracy of transvaginal ultrasonography in diabetic or obese women with postmenopausal bleeding

作　　者：VanDoornL.C. Dijkhuizen F. P. H. L. J. Kruitwagen R. F. M. P. 张会孝 

机构地区：[1]Department of Gynecological Oncology, Erasmus Medical Center, Univer sity of Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands Dr.

出　　处：《世界核心医学期刊文摘（妇产科学分册）》2005年第9期51-52,共2页Core Journal in Obstetrics/Gynecology

摘　　要：OBJECTIVE: We sought to assess the accuracy of endometrial thickness measure me nt in the diagnosis of endometrial cancer in patients with obesity, diabetes, an d hypertension and to evaluate whether patient characteristics influence endomet rial thickness irrespective of the final diagnosis. METHODS: This was a prospect ive study of women not using hormone replacement therapy who presented with post -menopausal bleeding at 8 hospitals in The Netherlands. All women underwent tra nsvaginal ultrasonography and, in the event that the endometrial thickness (doub le layer) was more than 4 mm, subsequent endometrial sampling. The performance o f endometrial thickness measurement in the diagnosis of atypical hyperplasia and endometrial cancer was evaluated in subgroups of patients with diabetes, hypert ension, and obesity by using receiver operating characteristic analysis. RESULTS : Overall, we included 594 consecutive women, of whom 62 (10%) had endometrial carcinoma and 6 (1%) had atypical hyperplasia. In these women, transvaginal ult rasonography had an area under the receiver operating characteristic curve of 0. 87 (standard error [SE] 0.03). In the absence of (pre) malignancy, women with di abetes or obesity were found to have thicker endometria than women without these risk factors, whereas in women with a (pre) malignancy, this difference was not present. The area under the receiver operating characteristic curve decreased t o 0.74 (SE 0.05) and 0.75 (SE 0.07) in diabetic women and obese women, respectiv ely. The presence or absence of hypertension had no impact on the accuracy of transvaginal ultrasonography. CONCLUSION: In view of the decreased diagnostic accuracy in diabetic women and obese women, the clinical value of transvaginal e ndometrial thickness measurement in these women is questionable.OBJECTIVE: We sought to assess the accuracy of endometrial thickness measure me nt in the diagnosis of endometrial cancer in patients with obesity, diabetes, an d hypertension and to evaluate whether patient characteristics influence endomet rial thickness irrespective of the final diagnosis. METHODS: This was a prospect ive study of women not using hormone replacement therapy who presented with post -menopausal bleeding at 8 hospitals in The Netherlands. All women underwent tra nsvaginal ultrasonography and, in the event that the endometrial thickness (doub le layer) was more than 4 mm, subsequent endometrial sampling. The performance o f endometrial thickness measurement in the diagnosis of atypical hyperplasia and endometrial cancer was evaluated in subgroups of patients with diabetes, hypert ension, and obesity by using receiver operating characteristic analysis. RESULTS : Overall, we included 594 consecutive women, of whom 62 (10%) had endometrial carcinoma and 6 (1%) had atypical hyperplasia. In these women, transvaginal ult rasonography had an area under the receiver operating characteristic curve of 0. 87 (standard error [SE] 0.03). In the absence of (pre) malignancy, women with di abetes or obesity were found to have thicker endometria than women without these risk factors, whereas in women with a (pre) malignancy, this difference was not present. The area under the receiver operating characteristic curve decreased t o 0.74 (SE 0.05) and 0.75 (SE 0.07) in diabetic women and obese women, respectiv ely. The presence or absence of hypertension had no impact on the accuracy of transvaginal ultrasonography. CONCLUSION: In view of the decreased diagnostic accuracy in diabetic women and obese women, the clinical value of transvaginal e ndometrial thickness measurement in these women is questionable.

关 键 词：阴道超声检查 协助诊断 子宫内膜厚度 经阴道超声 子宫内膜活检 绝经后阴道出血 肥胖人群 激素替代治疗 癌前病变 特征分析 

分 类 号：R445.1[医药卫生—影像医学与核医学]