岡田 理, 成松 昭夫

Osamu OKADA, Akio NARIMATSU

長門総合病院産婦人科

Department Obstetrics and Gynecology, Nagato General Hospital

キーワード : Endometrial cancer, Neoadjuvant chemotherapy, Screening, Transvaginal color Doppler ultrasonography

We studied the usefulness of transvaginal color Doppler ultrasonography in the screening and diagnosis of endometnal cancer. Subjects were 136 postmenopausal women who had not received hormone replacement therapy. Each subject was placed into one of three groups on the bases of results of endometrial histopathologic examination: group N, 120 normal women; group H,7 women in whom endometrial hyperplasia had been diagnosed; and group C, 9 women in whom endometnal adenocarcinoma had been diagnosed. Results of ultrasonic examination of the subjects in each group were then compared. Transvaginal ultrasonography was used to measure thickness of the endometrium (EM), evaluate the resistance index derived from flow-velocity waveforms recorded from the right and left uterine arteries (URI), and observe arterial blood flow in the intrauterine cavity (IUA). Thickness of the EM (mean±SD, mm) was4.8±1.8 in group N, 19.1±4.1 in group H, and 21.1±4.1 in group C; the EM of groups H and C were significantly thickened. URI (mean±SD) was 0.81±0.06 in group N, 0.75±0.04 in group H, and 0.73±0.04 in group C; levels in groups H and C were significantly low. IUA was observed in 1 subject in group H and 8 subjects in group C; it was not observed in group N, however. Four patients in group C received neoadjuvant chemotherapy with intra-arterial infusion. MRI and ultrasonography after chemotherapy showed a decrease in tumor size and disappearance of IUA. We felt that postmenopausal women with an EM 10 mm or more in thickness should undergo endometrial histologic examination. Some subjects with endometrial cancer and some of the normal women had low URI levels, so URI did not appear useful for screening endometrial cancer. We consider the presence of IUA to be suggestive of malignancy. IUA disappeared in patients who received chemotherapy. These findings demonstrate the usefulness of ultrasonic measurement EM and IUA in the screening of endometrial cancer.