摘要
目的探究以不同内膜厚度作为界值诊断选择性雌激素受体调节剂(SERM)所致子宫内膜病变的效果,以及分析SERM所致子宫内膜病变的可能危险因素。方法回顾性分析2001年5月至2016年5月98例口服SERM的绝经前乳腺癌患者因超声发现子宫内膜增厚行诊断性刮宫术或宫腔镜下子宫内膜活检术患者的临床资料。结果 98例患者中,4例(4.08%)出现子宫内膜增生性病变。以术前超声提示的内膜厚度≥10mm作为诊断标准,诊断的灵敏度为100%,特异度为28.72%,阳性预测值为5.63%,阴性预测值为100%;以≥15mm作为诊断标准,诊断的灵敏度为75%,特异度为68.08%,阳性预测值为9.09%,阴性预测值为98.46%。卡方分析提示年龄、用药时间、药物种类、停经史和症状等因素与内膜增生性病变无显著关联(P>0.05)。结论绝经前乳腺癌患者应用SERM后可能导致子宫内膜厚度增加,但子宫内膜增生性病变风险并没有明显增加,提示患者可减轻用药期间因子宫内膜增厚而产生的顾虑;经阴道超声检查仍是首选的筛查手段,当内膜厚度≥15mm或内膜厚度≥10mm伴有其它危险因素时建议进一步处理。
Objective：To evaluate the diagnostic efficiency of different endometrial thickness as the cutoff value for diagnosing uterine endometrial lesions caused by treatment of selective estrogen receptor modulators（SERM）,and analyze the possible risk factors of SERM induced endometrial lesions.Methods：The clinical data of 98 premenopausal patients who received SERM therapy and underwent diagnostic curettage surgery or hysteroscopic endometrial biopsy due to endometrial thickening found by ultrasound from May 2001 to May 2016 were retrospectively analyzed.Results：Among 98 patients,4（4.08%）had endometrial hyperplasia.When endometrial thickness revealed equal to or greater than 10 mm by ultrasonography was chosen as the cutoff value,the diagnostic sensitivity was 100%,the specificity 28.72%,the positive predictive value 5.63%,and negative predictive value 100%.When15 mm endometrial thickness was chosen as the cutoff value,the sensitivity was 75%,the specificity 68.08%,the positive predictive value 9.09%,and negative predictive value 98.46%.Chi square analysis indicated that age,duration and types of SERM,menopause duration and symptoms had no significant correlation with hyperplasia lesion（P0.05）.Conclusions：Administration of SERM may increase endometrial thickness,but do not significantly increase the risk of endometrial proliferative lesions in premenopausal patients.It is redundant for patients to be excessively anxious due to the endometrium thickening during administration of SERM.Transvaginal ultrasonography is still the preferred screening tool.Further examinations are recommended when endometrial thickness is≥15mm or≥10mm and accompanied by other risk factors.
出处
《生殖医学杂志》
CAS
2016年第10期937-942,共6页
Journal of Reproductive Medicine
