育龄期妇女子宫内膜病变的声像图表现与病理分析

目的分析育龄期妇女异常子宫出血的声像图表现与病理结果,探讨育龄期子宫内膜病变的诊断思路。 方法选取2001年10月至2016年9月在首都医科大学附属复兴医院就诊的子宫内膜病变育龄期妇女149例,分析其声像图表现与病理结果,分为子宫内膜增生过长组88例,子宫内膜息肉组41例,子宫内膜癌组20例;超声检查的时间为月经周期的增殖早期或阴道出血停止后3 d内,以宫腔回声厚径≥10 mm作为内膜增厚的标准。内膜息肉组与息肉样增生组患者间最大径比较采用独立样本t检验;子宫内膜增生过长组、子宫内膜息肉组与子宫内膜癌组之间年龄、子宫体三径之和、宫腔回声厚径比较采用方差分析,有统计学意义的组间两两比较采用Bonferroni检验;比较3组患者的声像图表现与病理结果;镜下病理观察卵巢的组织结构。 结果（1）子宫内膜增生过长组、子宫内膜息肉组及子宫内膜癌组患者的平均年龄比较,差异无统计学意义（P>0.05）。（2）超声检查：3组患者子宫体三径之和比较,差异无统计学意义（P>0.05）;内膜增生过长组的宫腔回声厚径与内膜息肉组及内膜癌组比较[（11.70±5.42）mm vs（10.59±3.83）mm vs（17.14±8.70）mm],差异有统计学意义（F=9.779,P<0.001）,内膜增生过长组与内膜癌组、内膜息肉组与内膜癌组宫腔回声厚径比较,差异均有统计学意义（P均<0.001）;内膜增生过长组与内膜息肉组宫腔回声厚径比较,差异无统计学意义（P>0.05）。88例内膜增生过长病例中53例表现为息肉样,息肉样隆起的最大径的平均值与内膜息肉组比较[（17.13±10.45）mm vs（12.14±4.67）mm],差异有统计学意义（t=3.112,P=0.002）;41例内膜息肉及53例息肉样增生组出现点、条状血流信号的比例分别为75.61%（31/41）,41.51%（22/53）。3组患者中宫腔回声的测值<10 mm占42.3%（63/149）。（3）病理检查：20例子宫内膜癌均为内膜样癌,11例子宫切除者中,高分化子宫内膜样癌7例,中分化3例,低分化1例;同时,切除卵巢的8例中,7例见多个闭锁卵泡,1例见单纯囊肿。88例子宫内膜增生过长组中单纯增生过长77例,1例伴不典型增生;复杂增生过长11例,3例伴不典型增生。41例子宫内膜息肉中非功能性息肉33例,功能性息肉3例,4例腺肌瘤性息肉中1例癌变。 结论在子宫内膜的增殖早期或阴道出血停止后3 d内,宫腔回声厚径≥10 mm提示子宫内膜异常;宫腔回声厚径<10 mm,不能排除子宫内膜异常;可监测是否排卵,超声动态监测是否排卵可提示有无子宫内膜异常生长的危险因素。     

Sonohysterography compared with endometrial biopsy for evaluation of the endometrium in tamoxifen-treated women.

OBJECTIVE: This study was performed to compare endometrial biopsy and sonohysterography for evaluation of the endometrium in tamoxifen-treated women. METHODS: Medical records were retrospectively reviewed to identify 51 consecutive tamoxifen-treated women who had sonohysterography and correlative endometrial biopsy for evaluation of postmenopausal bleeding or thickened endometrium of greater than 8 mm. Endometrial biopsy and sonohysterographic results were compared in all women, and for 27 (53%) women who had hysteroscopy with dilation and curettage, endometrial biopsy and sonohysterographic findings also were compared with surgical pathologic findings. RESULTS: Thirty-two (63%) of 51 sonohysterograms revealed endometrial polyps; 4 (8%) showed endometrium of greater than 5 mm; 14 (27%) showed endometrium of less than 5 mm; and 1 (2%) was inadequate. Endometrial biopsy findings were benign endometrium in 42 (82%), polyps in 4 (8%), and insufficient samples in 5 (10%). Among the adequate sonohysterograms, 64% (32 of 50) resulted in a diagnosis of polyps (95% confidence interval, 49%-77%) whereas the corresponding proportion for endometrial biopsy was 9% (4 of 46; 95% confidence interval, 2%-21%). For the group with hysteroscopy, 24 (92%) of 26 polyps were confirmed histopathologically; 1 polyp had complex hyperplasia. Polyps were present in 23 (89%) of 26 women with benign endometrium or insufficient samples by endometrial biopsy, and only 1 confirmed polyp was identified by endometrial biopsy. The sensitivity of sonohysterography for diagnosis of endometrial polyps (100%) was significantly higher than for endometrial biopsy (4%; P < .01). CONCLUSIONS: In tamoxifen-treated women, sonohysterography provides a significant improvement in sensitivity for diagnosis of endometrial polyps compared with endometrial biopsy.     

Transvaginal color and pulsed Doppler sonography of the endometrium: a possible role in reducing the number of dilatation and curettage procedures.

The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospective study involved 42 postmenopausal patients who were examined, prior to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vaginal bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cut-off value of 8 mm), rates of visualization, and the density of uterine, myometrial (peritumoral) and endometrial (intratumoral) vessels were used, along with pulsatility and resistive indices of these vessels, to assess and correlate with endometrium pathology. Endometrial thickness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in asymptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vessels in cases of endometrial carcinoma was 93% and 43% respectively, which was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carcinoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularity was found in the myometrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

宫腔镜与经阴道超声检查对绝经后子宫出血的诊断价值

目的比较宫腔镜与经阴道超声检查诊断绝经后子宫出血患者宫腔内病变的准确性。方法对有绝经后子宫出血病史的67例患者行阴道超声检查后,进行宫腔镜检查,记录检查结果,所有病例均行病理组织检查,最后将两种检查结果与病理组织检查结果进行比较,分别计算出敏感性、特异性、阳性预测率及阴性预测率。结果67例患者中29例经阴道超声检查为正常,其中16例(55.17%)病理证实子宫内膜无异常。38例经阴道超声检查诊断为宫腔病变的患者中有35例(92.11%)经病理组织检查证实。经阴道超声检查宫腔病变的敏感性、特异性、阳性预测率、阴性预测率分别为72.92%、84.21%、92.11%和55.17%。67例患者中18例宫腔镜检查为正常,其中1例(5.56%)病理组织检查证实有宫腔病变。49例宫腔镜检查诊断宫腔病变的患者中,46例(93.88%)经病理组织检查证实。宫腔镜检查的敏感性、特异性、阳性预测率、阴性预测率分别为97.87%、85.00%、93.88%和94.44%,其敏感性及阴性预测率显著高于阴道超声检查。结论经阴道超声检查是诊断绝经后子宫出血的首选检查方法;子宫内膜厚度大于4mm,宫腔镜直视下活检或诊断性刮宫是绝经后子宫出血的最佳诊断手段。     

Sonographic depiction of postmenopausal endometrium with transabdominal and transvaginal scanning.

The thickness of the endometrium was measured in postmenopausal women by both the transvaginal and transabdominal ultrasound approaches in two separate groups of patients. The first group consisted of 90 women who received a transabdominal scan of the endometrium before dilatation and curettage or hysterectomy for either postmenopausal bleeding or uterine prolapse. The second group consisted of 111 women who underwent a transvaginal scan of the endometrium for similar postmenopausal conditions.Both methods suggested that an endometrial thickness of 5 mm may be used as a cut-off level in the conservative management of patients with postmenopausal bleeding or in a screening program for endometrial carcinoma.Patient acceptance and image quality were better in the group examined transvaginally. The proximity of the transvaginal probe to the endometrium, in the absence of a full bladder compressing the endometrium, revealed a unique group of patients with atrophic endometrium but thick endometrial cavity caused by intracavity fluid. In the presence of uterine fibroids distorting the uterine cavity, transvaginal scanning was better than transabdominal scanning for visualizing the endometrium. The transabdominal full-bladder technique can be of value in detecting asymptomatic bladder pathology.     

Comparative study of transvaginal sonography and hysteroscopy for the detection of pathologic endometrial lesions in women with postmenopausal bleeding.

Dilatation and curettage is used as the "gold standard" for diagnosing pathologic endometrial lesions in women with postmenopausal bleeding. In this group of women, about 10% have an endometrial cancer and an additional 20% have some other endometrial abnormality. However, some abnormalities, such as endometrial polyps and submucous fibroids, are difficult to diagnose by dilatation and curettage. In such cases, combining transvaginal sonography with hysteroscopy may be of value. This study compared the use of transvaginal sonography and hysteroscopy for evaluation of the uterine cavity in women with postmenopausal bleeding. The study included 51 women, 39 of whom had an abnormally thick ( > 4 mm) endometrium as measured by transvaginal sonography, and 35 of 39 had an abnormal appearance at hysteroscopy. The sensitivity and specificity for the measurement of endometrial thickness using transvaginal sonography to diagnose an endometrial abnormality were 100% and 75%, respectively. The corresponding figures for hysteroscopy were 97% and 88%. In all women with an endometrial thickness of 8 mm as measured by transvaginal sonography, hysteroscopy is identified as an abnormality. The study indicates that transvaginal sonography reveals an endometrial thickness of > or = 8 mm and the histopathologic diagnosis after dilatation and curettage is atrophic endometrial polyp or submucous myoma.     

Vaginal ultrasonography in patients with postmenopausal bleeding.

Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post-menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0-6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol.     

宫腔镜检查在异常子宫出血中的应用价值

目的探讨宫腔镜检查在异常子宫出血（abnormal uterine bleeding，AUB）中的应用价值。方法对398例AUB患者进行宫腔镜检查，将发现的子宫内膜病变类型按不同年龄进行分组比较。结果萎缩性子宫内膜、子宫内膜癌、子宫内膜炎是绝经后出血的常见原因，而子宫内膜息肉及子宫内膜腺囊性增生过长是育龄期和围绝经期异常子宫出血的主要原因。结论宫腔镜检查对AUB的病因诊断具有重要价值，各个年龄阶段的AUB患者首选宫腔镜检查及定位取检是很有益处的。     

Transvaginal color Doppler sonography versus sonohysterography in the diagnosis of endometrial polyps.

OBJECTIVE: To compare the diagnostic performance of transvaginal color Doppler sonography (TVCD) and sonohysterography (SHG) in the diagnosis of endometrial polyps. METHODS: Fifty-one women (mean age, 51 years; range, 27-75 years) with clinical or B-mode sonographic suspicion of endometrial polyps were included in this prospective study. Transvaginal color Doppler sonography first and then SHG were performed in all patients. On TVCD, a polyp was suspected when a vascular pedicle penetrating the endometrium from the myometrium was identified. On SHG, a polyp was suspected when a focal polypoid lesion was seen within the endometrial cavity. All patients underwent hysteroscopy and endometrial biopsy, the findings of which were used as the criterion standard. Sensitivity and specificity for TVCD and SHG were calculated and compared by the McNemar test. RESULTS: Hysteroscopy and endometrial biopsy findings were as follows: endometrial polyps, 41; endometrial hyperplasia, 3; cystic atrophy, 4; proliferative endometrium, 2; and endometritis, 1. Sensitivity and specificity for TVCD and SHG were 95% and 80% and 100% and 80%, respectively (McNemar test, P = .5) CONCLUSIONS: Transvaginal color Doppler sonography and SHG had similar performance for diagnosing endometrial polyps.     

Diagnostic accuracy of endometrial thickness to exclude polyps in women with postmenopausal bleeding

PURPOSE: To determine the accuracy of endometrial thickness measurement with transvaginal ultrasonography (TVUS) to diagnose endometrial polyps in women with postmenopausal bleeding in whom a carcinoma has been ruled out. METHODS: In women with postmenopausal bleeding, endometrial thickness was measured with TVUS. If endometrial thickness was >4 mm, office hysteroscopy was performed. At hysteroscopy, the uterine cavity was assessed for the presence of polyps. Patients with malignancy were excluded. We used receiver operating characteristics (ROC) analysis to assess the capacity of TVUS endometrial thickness measurement to diagnose endometrial polyps. Findings at hysteroscopy were considered to be the reference standard. RESULTS: We included 178 patients with postmenopausal bleeding and endometrial thickness >4 mm. Hysteroscopy showed an endometrial polyp in 90 patients (50%). The ROC analysis revealed that endometrial thickness had an area under the curve of 0.64 in the diagnosis of endometrial polyps. CONCLUSION: In women with postmenopausal bleeding in whom carcinoma has been ruled out, measurement of endometrial thickness with TVUS is not useful in the diagnosis of endometrial polyps.     

宫腔镜在协助诊断异常子宫出血中的价值

【目的】探讨宫腔镜协助诊断异常子宫出血的价值和优势。【方法】应用宫腔镜检查262例异常子宫出血患者,并在宫腔镜下定位取材或诊断性刮宫。【结果】宫腔镜诊断手宫黏膜下肌瘤、子宫内膜息肉、萎缩型子宫内膜、子宫内膜炎的敏感性高,宫腔镜检查与病理检查结果总符合率93．35％。萎缩型子宫内膜、子宫内膜炎是本组患者绝经后出血的主要原因,子宫内膜增生症、子宫内膜息肉是绝经前异常子宫出血的主要原因。【结论】宫腔镜检查能直视宫腔内病变,定位取材送病理检查可提高诊断准确率,对部分病人可达到诊断和治疗一体化的作用。     

经阴道超声监测服用TAM的乳腺癌患者子宫内膜病变的价值分析

目的:探讨经阴道超声监测服用他莫昔芬TAM的乳腺癌患者子宫内膜病变的有效方法。材料和方法:回顾分析2010年1月-2019年1月首都医科大学附属北京妇产医院和北京市大兴区人民医院共94例乳腺癌术后服用TAM病人,对可疑子宫内膜病变者实行诊刮或手术获得组织病理学结果,进行病理与经阴道超声结果对照分析。结果:94例乳腺癌病人中,子宫内膜病理良性组78例(包括正常内膜8例、增生及复杂增生32例、息肉及息肉样增生28例及萎缩内膜10例),恶性组16例(包括非典型增生5例,高分化腺癌2例,中低分化腺癌5例,浆液性癌2例,恶性中胚叶混合瘤1例,透明细胞癌1例)。两组病人经阴道超声资料比较,在子宫内膜回声,内膜是否出现小囊性改变,内膜是否出现息肉样变,内膜与肌层界限情况及出现宫腔积液情况等指标上存在明显差异。而在子宫内膜厚度上差异不明显。结论:乳腺癌术后服用TAM病人经阴道超声检查如出现子宫内膜回声不均、子宫内膜出现息肉样变、内膜与肌层界限不清及宫腔积液者要高度警惕子宫内膜发生恶变可能,应提示临床尽早刮宫行组织病理学检查,而子宫内膜出现小囊变则良性内膜发生几率高。单纯依靠子宫内膜厚度测量尚不能做为超声判断子宫内膜良恶性的指标。     

经阴道超声测量对绝经后子宫内膜癌的诊断价值

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。     

Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium.

OBJECTIVE: To evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography. METHODS: Ninety-one postmenopausal women (median age, 58 years; range, 47-83 years) presenting with uterine bleeding and a thickened endometrium (> or = 5-mm double-layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B-mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple-vessel pattern, Pattern B: single-vessel pattern and Pattern C: scattered-vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included. RESULTS: Histological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%. CONCLUSIONS: Transvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.     

经阴道超声与宫腔镜检查诊断绝经后服用他莫昔芬妇女子宫内膜病变的比较

目的 该研究比较了经阴道超声（transvaginal ultrasonography,TVS）与宫腔镜检查（hysteroscopy,HS）在诊断绝经后服用他莫昔芬（tamoxifen,TAM）对子宫内膜病变的价值,以探讨与其相关的监测方法.方法 随诊了46例绝经后因乳腺癌服用TAM（20mg/d）超过6个月的妇女.所有患者均施行了TVS、HS以及内膜组织病理学检查.TVS以子宫内膜厚度≥5mm为阳性判断标准.结果 TVS检查结果阳性21例（45.7%）中,经HS及病理诊断证实内膜息肉14例,单纯增殖型内膜2例,萎缩型内膜5例;TVS检查结果阴性25例（54.3%）中,内膜息肉8例,单纯增殖型内膜3例,萎缩型内膜14例.TVS检查的特异性为70.8%,敏感性为63.6%,阳性预测值为66.7%,阴性预测值为68.0%.而HS分别为100%、96.0%、95.7%和95.7%.息肉病人的TVS结果与非息肉病人比较差异有显著性（P=0.019）.结论 由于TAM对绝经后的子宫内膜具有雌激素样作用,能够引起内膜基质水肿,产生类似增生内膜的超声影像,导致TVS的检查结果与HS下所见以及内膜病检不相符.服用TAM的绝经后乳腺癌患者,单纯以TVS作为其内膜病变的筛选方法具有一定诊断价值,但存在较高的假阳性率且特异性较差.在确诊子宫内膜息肉方面HS具有特殊优势.     

Benign endometrial adenofibroma and polyp in patients receiving tamoxifen: findings on transvaginal ultrasonography and magnetic resonance imaging

Tamoxifen, a selective estrogen receptor modulator, is widely used to treat breast cancer, but an association has been reported between tamoxifen and the development of endometrial lesions, including endometrial carcinoma, endometrial polyps, and endometrial hyperplasia. There have also recently been a few reports on the relation between tamoxifen and adenofibroma. We present two case reports, one of a patient with a uterine adenofibroma and one of a patient with an endometrial polyp, both of whom received tamoxifen. Cases 1 and 2 are 75- and 65-year-old postmenopausal women, respectively, undergoing tamoxifen therapy. In both cases, endometrial thickening and many small cysts in the uterine cavity were revealed by transvaginal ultrasonography or magnetic resonance imaging. Postoperative microscopic examination confirmed the mass as an adenofibroma in case 1 and as an endometrial polyp in case 2.     

子宫内膜癌与子宫内膜增生过长病变超声与病理对比分析

目的探讨子宫内膜癌与子宫内膜增生过长病变超声与病理学表现及超声提示子宫内膜癌的诊断指征。方法对病理证实的209例子宫内膜癌及子宫内膜增生过长患者(子宫内膜癌组101例,子宫内膜增生组108例)的子宫内膜病变超声声像图表现、子宫内膜病变内血流动力学特点及病理检查结果进行对比分析。结果子宫内膜癌组和子宫内膜增生组患者子宫内膜病变超声及病理学表现:(1)子宫腔回声厚径:超声声像图示子宫内膜癌组101例患者子宫腔回声厚径为4.60～59.00mm,平均(20.00±0.92)mm,子宫内膜增生组108例患者子宫腔回声厚径为3.80～43.90mm,平均(12.53±5.71)mm,两组患者子宫腔回声平均厚径比较差异有统计学意义(t=6.362,P<0.01)。(2)子宫内膜病变血流动力学特点:子宫内膜癌组21例患者(21/101,20.79%)子宫内膜病变呈高阻力动脉血流[阻力指数(RI)≥0.5],31例(31/101,30.69%)呈低阻力动脉血流(RI<0.5),37例(37/101,36.63%)呈高低阻力动脉血流共存;子宫内膜增生组77例患者(77/108,71.3%)子宫内膜病变呈高阻力动脉血流(RI≥0.5),6例(6/108,5.56%)呈低阻力动脉血流(RI<0.5),17例(17/108,15.74%)呈高低阻力动脉血流共存;子宫内膜癌组患者子宫内膜病变呈高阻力动脉血流的检出率(20.79%,21/101)低于子宫内膜增生组(71.30%,77/108),而子宫内膜病变呈低阻力及高低阻力动脉血流共存的检出率(36.63%,37/101)高于子宫内膜增生组(15.74%,17/101)。(3)子宫内膜病变病理诊断结果 :两组209例患者(子宫内膜癌组101例患者中全切子宫88例,宫腔镜手术活检8例,诊断性刮宫5例;子宫内膜增生组108例患者中全切子宫11例,宫腔镜手术活检78例,诊断性刮宫19例)病理镜下示子宫内膜癌组49例(49/101,48.51%)癌与子宫内膜增生过长病变并存,其余病灶癌旁可见子宫内膜单纯性(1例)、复杂性(1例)、非典型性增生病变(4例)和增殖期(5例)与萎缩性子宫内膜(17例),而子宫内膜增生组患者病理镜下示子宫内膜呈单纯性(89例)、复杂性(11例)和非典型性增生病变(8例)。208例患者子宫内膜病变术前诊断性刮宫提示子宫内膜单纯性增生过长90例(全切子宫病理诊断为子宫内膜癌1例,1/90,1.10%)、子宫内膜复杂性增生过长12例(全切子宫病理诊断为子宫内膜癌1例,1/12,8.33%)、子宫内膜不典型增生12例(全切子宫病理诊断为子宫内膜癌4例,4/12,33.33%)。超声与病理对比分析结果显示,诊断性刮宫提示子宫内膜不典型增生的符合率(33.33%)明显多于子宫内膜复杂性增生过长(8.33%)和子宫内膜单纯性增生过长(1.10%)。结论超声检查高度怀疑子宫内膜癌的诊断指征为:(1)宫腔回声增厚伴有低阻力动脉血流或高低阻力动脉血流并存;(2)宫腔回声增厚伴高阻力动脉血流(RI≥0.5),且该病例诊断性刮宫病理诊断为子宫内膜不典型增生;(3)超声检查提示子宫内膜息肉样病变,且该病例诊断性诊刮病理诊断为子宫内膜不典型增生。     

子宫癌肉瘤的超声表现与病理特征

目的分析子宫癌肉瘤的超声声像图表现及病理组织学特点，提高对本病的认识。 方法回顾性收集2009年1月至2018年12月首都医科大学附属复兴医院收治并经病理证实的6例子宫癌肉瘤患者的临床资料，分析其超声声像图表现与病理组织学特点。 结果6例子宫癌肉瘤患者均为绝经后女性，临床表现为绝经后不同程度的阴道出血。超声表现：绝经后子宫测值增大，6例患者子宫三径之和132～248 mm，平均（199.7±36.8）mm，宫腔回声明显增厚呈息肉样，内呈不均质中高或中低回声，最大径14～81 mm，最大径平均值（47.2±21.3）mm；肿瘤部分边界清晰，可见“亮边”，形态欠规则，部分与肌层分界不清；血流评分3例4分，2例3分，1例2分，均可测及动脉血流频谱（阻力指数：0.15～0.59）。病理检查：3例为中分化子宫癌肉瘤，3例为低分化子宫癌肉瘤；镜下病理见瘤体内血管丰富；6例均伴有肌层浸润。 结论子宫癌肉瘤多表现为绝经后阴道出血伴体积较大的息肉样病变，基底部粗大的供养血管多提示肌层浸润，宫腔镜检查可获得病理诊断。     

Color Doppler sonography of endometrial masses.

OBJECTIVE: To correlate the color Doppler sonographic features of endometrial masses with histologic characteristics and microvessel density. METHODS: We performed a retrospective analysis of 10 postmenopausal and 5 premenopausal women with abnormal bleeding who had color Doppler sonography and histologic studies of endometrial masses. RESULTS: Endometrial masses that contained multiple branches on color Doppler sonography were more likely carcinomas, even though both polyps and carcinomas were vascular on color Doppler sonography and their microvessel densities were similar. On color Doppler sonography, polyps averaged 1.2 detectable vessels versus 3.4 for carcinomas. CONCLUSIONS: Color Doppler sonography may be useful in distinguishing carcinomas from polyps in women with thickened endometria.