| 摘要: |
| 目的：探讨55岁及以下乳腺癌术后患者出现子宫内膜及卵巢病变的临床及超声监测价值
方法：回顾性分析首都医科大学北京妇产医院及首都医科大学大兴教学医院2011年1月至2021年10月以来所有55岁及以下乳腺癌术后患者临床怀疑出现子宫及卵巢病变的病例共148例，所有病例均做出了诊刮或手术取得了子宫内膜织学病理或做出随访观察，根据组织学病理结果应用X2检验及独立样本T检验统计分析出55岁及以下乳腺癌术后患者出现子宫及卵巢恶性病变特点，并应用统计积分量化的方式分析经阴道超声监测子宫内膜恶性病变的价值。
结果：首先根据病例是否应用他莫昔芬TAM治疗分为TAM组87例及非TAM组61例，根据子宫内膜诊刮及手术病理两组出现良性及恶性子宫内膜比例进行统计学比较得出P=0.712；进而对所有子宫内膜良性组共128例及恶性组共20例病例的病人一般资料及超声声像图各指标进行分别统计，两组病例在病人体重指数（P=0.048）、乳腺癌术后时间（P=0.000）、家族史（P=0.005）及是否出现临床症状（P=0.000）上存在明显差异，超声指标上在子宫内膜回声是否均匀（P=0.038）、内膜是否存在囊性变（P=0.038）、内膜有无息肉样变（P=0.000）、有无宫腔积液（P=0.000）及内膜是否存在动脉血流（P=0.000）上均存在明显差异。采用超声指标积分量化的方式评估子宫内膜恶性病变，当积分≥2分时诊断的敏感性及特异性分别为70%及82%，而当超声积分≥3分时诊断的敏感性较低约40%，但特异性较高约96%。本研究148例乳腺癌病人中63例发现卵巢包块，62例为囊性、部分囊内伴有细分隔，1例为囊实性，手术病理均为良性病变或在随访中缩小或消失。
结论：本研究服用TAM的乳腺癌术后患者子宫内膜恶性变的发生率与未服用者比较无明显差异。本研究中子宫内膜恶性病例的总体发生率较高，为13.5%，临床上乳腺癌术后患者出现体重指数增加、乳腺术后时间较长、有恶性肿瘤家族史及出现妇科临床症状的患者出现子宫内膜恶变机率增加；超声图像上显示子宫内膜回声不均、内膜出现息肉样变、宫腔积液及内膜存在动脉血流应警惕出现子宫内膜恶变；而乳腺癌患者出现卵巢病变本组均为良性或可自行吸收。临床上可以尝试应用超声指标积分量化的方式评估子宫内膜恶性病变。 |
| 关键词: 55岁及以下 乳腺癌术后 子宫内膜病变 卵巢病变 |
| DOI： |
| 投稿时间：2021-11-25修订日期：2022-02-10 |
| 基金项目: |
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| Value of monitoring uterine and ovarian lesions in patients aged 55 and under after breast cancer surgery |
| liujingyan,wuqingqing,wangjingjing |
| (Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital) |
| Abstract: |
| Objective: To investigate the clinical and ultrasonic monitoring value of endometrial and ovarian lesions in patients aged 55 and below after breast cancer surgery
Methods: Retrospective analysis of Beijing Obstetrics and Gynecology Hospital and Daxing Teaching Hospital of Capital Medical University with all patients aged 55 and younger after breast cancer surgery from January 2011 to October 2021,a total of 148 cases were suspected to have uterine and ovarian lesions.all cases were made the diagnosis scraping the operations or the endometrial tissue pathology or make follow-up observations. According to the histological and pathological results, X2 test and independent sample T test were used to analyze the characteristics of malignant lesions of uterus and ovary in patients aged 55 and below after breast cancer surgery, and the value of transvaginal ultrasound monitoring endometrial malignant lesions was analyzed by statistical integral quantification method.
Results: Firstly, 87 cases were divided into TAM group and 61 cases were divided into non-TAM group according to whether tamoxifen TAM was used. According to the proportion of benign and malignant endometrium in endometrial curettage and surgical pathology, a statistical comparison was made, P=0.712. Then, the general data and ultrasonographic indicators of all the patients in the benign group (128 cases) and the malignant group (20 cases) were statistically analyzed. There were significant differences in body mass index (P=0.048), postoperative time of breast cancer (P=0.000), family history (P=0.005) and clinical symptoms (P=0.000) between the two groups. There were significant differences in endometrial echogenicity (P=0.038), endometrial cystic changes (P=0.038), endometrial fleshy changes (P=0.000) 、whether there is uterine effusion (P=0.000)and endometrial arterial blood flow (P=0.000). In the evaluation of endometrial malignant lesions by means of integral quantification of ultrasonic indicators, the sensitivity and specificity of the diagnosis were 70% and 82% when the ultrasound score was ≥2, while the sensitivity was 40% lower when the ultrasound score was ≥3, but the specificity was 96% higher.
In this study, ovarian masses were found in 63 of 148 patients with breast cancer, 62 cases were cystic, some cystic with fine septum, and 1 case was cystic solid. Surgical pathology was benign or narrowed or disappeared during follow-up.
Conclusion: In this study, there was no significant difference in the incidence of endometrial malignant changes between patients who took TAM after breast cancer surgery and those who did not. In this study, the overall incidence of endometrial malignancy was relatively high, accounting for 13.5%. Clinically, patients with breast cancer after surgery had increased body mass index, had a longer postoperative period of breast cancer, had a family history of malignant tumor and had gynecological clinical symptoms, had an increased probability of endometrial malignancy. Ultrasound images showed uneven endometrium echo, endometrium polypoid changes，uterine cavity effusion and the presence of endometrium arterial blood flow. However, ovarian lesions in breast cancer patients were benign or self-absorbed. In clinic, we can try to evaluate endometrial malignant lesions by means of integral quantification of ultrasonic indicators |
| Key words: Aged 55 and below Breast cancer surgery Endometrial disease Ovarian lesions |
