Ultrasound screening in gynecological examinations: can we overcome the criticism that it is insufficient and harmful?
Ultrasound screening in gynecological examinations: can we overcome the criticism that it is insufficient and harmful?
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妇科检查中的超声筛查：我们能否克服其不足和有害的批评？
DOI：
10.1007/s10396-021-01174-3
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发表时间：
2022
影响因子：
1.8
通讯作者：
Naruse Katsuhiko
中科院分区：
文献类型：
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作者：
Ryoko Asano;Mikiko Asai-Sato;Taichi Mizushima;Etsuko Miyagi.;Naruse Katsuhiko
在妇科肿瘤检查中，超声检查与阴道细胞学检查同时进行。传统上，我们依赖于盆腔检查（双手触诊），但其准确性不高，并且不可避免地受到某些因素的影响，例如患者的体重指数[1]。此外，经阴道超声检查的广泛应用提高了卵巢肿瘤和子宫肌瘤的检出率，另一方面，常规超声检查对卵巢癌和子宫内膜癌的检出并不完全相关，无助于降低死亡率，无效，并可能导致过度诊断[2]。我们应该意识到，在妇科检查中使用超声并没有达成共识。这可能是因为超声诊断能力有限，以确定是否卵巢肿瘤是良性或恶性，因为病理诊断不能证实没有手术组织学。此外，筛查测试的目标应该是早期发现，以降低疾病风险并改善预后。然而，到目前为止，卵巢癌的超声筛查尚未能够改善结果，这可能是由于其难治性[2]。另一方面，子宫内膜癌进展缓慢，即使基于其他主观症状较晚发现，预后也不那么差，这被认为降低了使用超声检查筛查无症状个体的优先性。
Ultrasound is performed simultaneously with vaginal cytology in many facilities during examinations focused on gynecologic tumors. Traditionally, we have relied on the pelvic examination (bimanual palpation), but its accuracy has not been high, and the influence of certain factors, such as the patient’s body mass index, have been unavoidable [1]. In addition, widespread use of transvaginal ultrasonography has improved the detection of ovarian tumors and uterine fibroids.On the other hand, it has been observed that routine ultrasonography for the detection of ovarian and uterine endometrial cancers is not entirely relevant, does not contribute to mortality reduction, is not valid, and may lead to overdiagnosis [2]. We should be aware that there is no consensus on the use of ultrasound in gynecological examinations. This is probably because of the limited ability of ultrasound diagnosis to determine whether ovarian tumors are benign or malignant and because a pathological diagnosis cannot be confirmed without operative histology. In addition, the goal of a screening test should be early detection to reduce the risk of disease and improve prognosis. However, thus far, ultrasound screening of ovarian cancer has not been able to improve outcomes, which may be due to its refractoriness [2]. On the other hand, endometrial cancer progresses slowly, and the prognosis is not so poor even when detected later based on other subjective symptoms, which is thought to reduce the priority of using ultrasonography for screening of asymptomatic individuals.