绝经后首次出血后子宫内膜活检良性或不确定报告的诊断性检查

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-04-20 DOI:10.1016/j.ejogrb.2025.113991

F.Ciska Slaager , Johanna A. van der Zande , Lucy A. van Werkhoven , Laura D.P.R. van Maldegem , Maria C. Breijer , Manja Z. Dorman , Peggy M.L.H. Vencken , Judith de Waard , Ward Hofhuis , Gatske M. Nieuwenhuyzen-De Boer , Heleen J. van Beekhuizen , Klaas Hoogduin , A. Lex C.F. Makkus , Nicole van Es , Patricia C. Ewing-Graham , Helena C. van Doorn

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引用次数: 0

摘要

背景：绝经后出血有发生子宫内膜癌的风险，办公室子宫内膜取样（OES）通常是第一种诊断方法。是否需要进一步的诊断程序，如宫腔镜或生理盐水输注超声检查（SIS）来排除息肉和恶性肿瘤是不确定的。本研究的目的是评估临床医生是否在OES为良性或不确定时进行进一步的诊断测试。次要结局包括与进行进一步诊断检查的可能性相关的患者特征以及子宫内膜上皮内瘤变和子宫内膜恶性肿瘤的发生率。方法：我们进行了一项多中心、前瞻性队列研究，评估首次绝经后出血、二维阴道超声检查子宫内膜厚度为4mm、OES结果为良性或不确定的患者。接受进一步诊断或治疗程序（宫腔镜或SIS）的患者与未接受进一步诊断或治疗程序的患者进行比较。进行单因素和多因素分析，以确定额外诊断程序和子宫内膜恶性肿瘤诊断的预测因素。结果在350例符合条件的患者中，197例（56%）接受了进一步的诊断程序。这些患者的子宫内膜较厚(中位数8.6 mm vs. 6.0 mm；p & lt;0.001)，更频繁地怀疑腔内异常(34.0% vs. 14.4%；p & lt;0.001)，更频繁的抽吸样本不足(20.8% vs. 11.8%；P = 0.025)。多元回归分析证实了这些发现。良性样本的潜在恶性风险为2.7%，而样本不足的潜在恶性风险为6.8%。总体而言，接受进一步诊断的患者的恶性肿瘤发生率更高（p = 0.04）。结论：在这项前瞻性研究中，超过一半的患者接受了进一步的诊断程序。子宫内膜厚度、怀疑腔内异常或子宫内膜样本不足是进一步诊断的预测指标。在接受诊断检查的患者中，恶性肿瘤的发生率较高，这表明在临床决策中应采取基于风险的策略。注册：在Erasmus MC （MEC 2015-740）获得中央研究批准。该研究已在荷兰试验登记处注册（www.onderzoekmetmensen.nl, NL7608）。

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Diagnostic workup of patients with benign or inconclusive reports on office endometrial biopsy after first episode of postmenopausal blood loss

Background

Postmenopausal bleeding carries a risk of endometrial cancer, and office endometrial sampling (OES) is often the first diagnostic approach. Whether further diagnostic procedures such as hysteroscopy or saline infusion sonography (SIS) are required to rule out polyps and malignancies is uncertain. The objective of this study is to evaluate whether clinicians perform further diagnostic tests when OES is benign or inconclusive. Secondary outcomes include the patient characteristics associated with the likelihood of performing further diagnostic tests and the incidence of endometrial intraepithelial neoplasia and endometrial malignancy.

Methods

We performed a multicenter, prospective cohort study, evaluating patients with a first episode of postmenopausal bleeding, with an endometrial thickness of >4 mm on 2D vaginal sonography and a benign or inconclusive result of an OES. Patients who underwent further diagnostic or therapeutic procedures (hysteroscopy or SIS) were compared to patients who did not. Univariate and multivariate analyses were performed to identify predictive factors for additional diagnostic procedures and the diagnosis of endometrial malignancy.

Results

Of the 350 eligible patients, 197 (56 %) underwent further diagnostic procedures. These patients had a thicker endometrium (median 8.6 mm vs. 6.0 mm; p < 0.001), more frequent suspicion of intracavitary abnormalities (34.0 % vs. 14.4 %; p < 0.001), and more frequent insufficient aspiration samples (20.8 % vs. 11.8 %; p = 0.025) compared to patients who received expectant management. Multivariate regression analysis confirmed these findings. The underlying risk of malignancy was 2.7 % with benign samples and 6.8 % with insufficient samples. Overall, malignancy incidence was higher in those who underwent further diagnostic workup (p = 0.04).

Conclusion

In this prospective study, just over half of patients underwent further diagnostic procedures. Endometrial thickness, suspicion of intracavitary abnormality or an insufficient endometrial sample were predictive for further diagnostic workup. The incidence of malignancy was higher in patients who underwent diagnostic workup, which argues for a risk-based strategy in clinical decision-making.

Registration: Central study approval was obtained at the Erasmus MC (MEC 2015-740). The study was registered in the Dutch trial register (www.onderzoekmetmensen.nl, NL7608).

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.