POSTMENOPOZAL VAJİNAL KANAMALI OLGULARDA TRANSVAJİNAL ULTRASONOGRAFİ VE BİOPSİ SONUÇLARININ KARŞILAŞTIRILMASI
Öz
Amaç: Postmenopozal kanaması olan hastaların endometrial
transvajinal ultrasonografi (TvUSG) bulgularının histopatoloji bulgularıyla
karşılaştırılması ve TvUSG'nin endometrial patolojilerin değerlendirilmesindeki
etkinliğinin belirlenmesi.
Materyal ve Metod: Çalışmada 01.01.2009-30.11.2012 tarihleri
arasında postmenopozal kanama nedeni ile takip edilen 135 hasta retrospektif
olarak değerlendirildi. Tüm hastalara TvUSG ile endometrial
kalınlık ölçümünü takiben endometrial biyopsi yapıldı. Yaş ve endometrial
kalınlığın malignite ve patoloji varlığı ile ilişkisi araştırıldı.
Sayısal veriler ortalama +/- standart sapma (SD) veya ortanca (minimum-maksimum)
olarak ifade edildi.
Bulgular: Hastaların yaş ortalaması 54±8 olarak bulundu. Patoloji
tespit edilen hastalar 10mm (5-40); patolji tespit edilmeyen hastalar
ise 7mm (2-13) endometrial kalınlığa sahipti (p<0.001). 7.5 mm eşik
değer kabul edildiğinde patoloji varlığı %82 sensitivite ve %58 spesifite
ile tespit edilebilmekteydi (AUC=0.82; p<0.001). Malign hastalar
11.5 mm (5-40); benign olanlar ise 8mm (7-27) endometrial kalınlığa
sahipti (p=0.001). 8.5 mm eşik değer kabul edildiğinde malignite %83
sensitivite ve %56 spesifite ile tespit edilebilmekteydi (AUC=0.78;
p=0.001).
Sonuç: Kurumumuza postmenopozal kanama ile başvuran hastalarda
TvUSG ile endometrial kalınlığın değerlendirilmesi, endometrial
patoloji ve malignite varlığını yüksek duyarlılıkla tespit edebilmektedir.
Anahtar Kelimeler
Postmenopozal Kanama Endometrial Kal›nl›k Transvajinalsonografi.
Kaynakça
- 1. Rodger FE, Walker J, Critchley HOD: Investigating the woman with postmenopausalbleeding. TrendsIn UGSH, 10:1-4 , 2005.
- 2. Yumru AE, Bozkurt M, Caylan O: Postmenopozal kanamal› vakalarda transvajinalsonografi, tan›sal histeroskopi ve histeroskopi sonras› biyopsinin de¤erlendirilmesi. Uluda¤ Universitesi T›p Fakultesi Dergisi, 30:97-101, 2004.
- 3. Oriel KA, Schrager S: Abnormaluterinebleeding. AmericanFamilyPhysician, 60:1371-1382, 1999.
- 4. Hurd WW. AbnormalBleeding. InBerek JS, Adashi EY, Hillard PA. Menopause. Novak’sGynecology. Pennsylvania. Williams &WilkinsCompany, 1996.
- 5. Loverro G, Bettocchi S, Cormio G, et al. Transvaginalsonographyandhysteroscopy in postmenopausaluterinebleeding. Maturitas 1999;33:139-44.
- 6. Dijkhuizen FPHLJ, Mol BWJ, Brolmann HAM, et al: Cost-effectiveness of the use of transvaginalsonography in the evaluation of postmenopausalbleeding. Maturitas, 45: 275-282, 2003
- 7. Gredhnark T, Kvint S, Havel G, et al: Histopathological Findings in Women with PostrnenopausalBleeding. British Journal of ObstetricsandGynaecology. 1995; 102.8:133-6.
- 8. Schramm T, Kurzl R, Schveighart C, et al: Endometrial Carcinoma and Vaginal Ultrasound Studies of The DiagnosticVolidirty. Geburtshilfe-Frauenheilkd. 1995; 55 (2):65-
- 9. Güner H, T›rafl MB, Karabacak O ve ark: Postmenopozal Kanamal› Hastalarda Vaginal Ultrasonografi ile Endometrial De¤erlendirme Diagnostik Kürtajlar› Azaltabilir mi?. T Klinik Jinekoloji Obstetrik Dergisi 1995; 5:298-302.
- 10. Osmers R, Völksen M, Schauer A: Vaginosonography for earlydetection of endometrial carcinoma.Lancet 1990;335:1569-73.
- 11. Karlsson B, Granberg S, Wiktand M, et al: TransvaginalUltrasonography of the Endometrium in Women with PostmenopausalBleeding- A NordicMulticenterStudy. Am J Obstet-Gynecol1995;172:1488-94.
- 12. fiener AB, Ekici E, Seçkin N ve ark: Postmenopozal kanama yak›nmas› ile gelen hastalarda vaginal ultrasonografi ile endometrial ölçüm ve endometrial biyopsinin karfl›laflt›r›lmas›. Jinekoloji ve Obstetride Yeni Görüfl ve Geliflmeler 1991; 3: 9-13.
- 13. Bakos 4, Smith P, Heimer G. TransvaginalUltrasonography for ‹dentifyingEndometrialPathology in PostmenopausalWomen. Maturitas 1994; 20: 181-9.
- 14. Litta P, Merlin F, Saccardi C, et al : Role of hysteroscopy with endometrialbiopsytoruleoutendometrialcancer in postmenopausalwomen with abnormaluterinebleeding. Maturitas, 50:117-123, 2005.
- 15. Fistonic I, Hodek B, Klaric P, et al: Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausalbleeding. J Clin Ultrasound, 25: 431-435, 1997.
- 16. Ferrazzi E, Torri V, Trio D, et al: Sonographic endometrial thickness: a useful test topredictatrophy in patients with postmenopausalbleeding. Ultrasound Obstet Gynecol, 7: 315-321, 1996.
- 17. Granberg S, Wikland M, Karlsson B, et al. Endometrialthickness as measuredbyendovaginalultrasonography for identifyingendometrialabnormality. Am J ObstetGynecol 1991; 164:47-52
- 18. Varner ER, Sparks JM, Cameron CD, et al. TransvaginalSonography of the Endmetrium in PostmenapausalWomen. ObstetGynecol 1991; 78:195-9.
- 19. Malinova M, Pehlivano B. Transvaginal Sonography and Endometrial Thickness in Patients with PostmenopausalUterineBleeding. EuropeanJournal of ObstetricsGynecology and Reproductive Biology. 1995; 58: 161-5.
Öz
Objective: To compare the endometrial transvaginal ultrasonography
(TvUSG) findings with histopathology and to assess the efficacy
of TvUSG for detecting endometrial pathologies in patients with
postmenopausal bleeding.
Material-Methods: One hundred and thirty-five patients who
refered between 01.01.2009-30.11.2012 with the complaint of postmenopausal
bleeding were retrospectively evaluated. After measuring
endometrial thickness with TvUSG, endometrial sampling was
performed and the histopathology results were compared with ultrasonographic
findings.
Results: The average age of patients was 54±8. Median endometrial
thickness was 10mm in pathologic group (5-40); and 7mm in nonpathologic
group (2-13) (p<0.001). When 7.5 mm has been accepted as
cut-off value, the pathology has been detected with 82% sensitivity
and 58% specificity (AUC=0.82; p<0.001). Median endometrial thickness
was 11.5 mm (5-40) in patients with malignity and 8 mm (7-27)in
benign patients (p=0.001). When 8.5 mm has been accepted as cut-off
value, the pathology has been detected with 83% sensitivity and 56%
specificity (AUC=0.78; p=0.001).
Conclusions The evaluation of endometrial thickness can detect
presence of pathology or malignity with high sensitivity in patients
referred with postmenopausal bleeding in our clinic
Anahtar Kelimeler
Postmenopausal Bleeding Endometrial Thickness Transvaginal Ultrasonography.
Kaynakça
- 1. Rodger FE, Walker J, Critchley HOD: Investigating the woman with postmenopausalbleeding. TrendsIn UGSH, 10:1-4 , 2005.
- 2. Yumru AE, Bozkurt M, Caylan O: Postmenopozal kanamal› vakalarda transvajinalsonografi, tan›sal histeroskopi ve histeroskopi sonras› biyopsinin de¤erlendirilmesi. Uluda¤ Universitesi T›p Fakultesi Dergisi, 30:97-101, 2004.
- 3. Oriel KA, Schrager S: Abnormaluterinebleeding. AmericanFamilyPhysician, 60:1371-1382, 1999.
- 4. Hurd WW. AbnormalBleeding. InBerek JS, Adashi EY, Hillard PA. Menopause. Novak’sGynecology. Pennsylvania. Williams &WilkinsCompany, 1996.
- 5. Loverro G, Bettocchi S, Cormio G, et al. Transvaginalsonographyandhysteroscopy in postmenopausaluterinebleeding. Maturitas 1999;33:139-44.
- 6. Dijkhuizen FPHLJ, Mol BWJ, Brolmann HAM, et al: Cost-effectiveness of the use of transvaginalsonography in the evaluation of postmenopausalbleeding. Maturitas, 45: 275-282, 2003
- 7. Gredhnark T, Kvint S, Havel G, et al: Histopathological Findings in Women with PostrnenopausalBleeding. British Journal of ObstetricsandGynaecology. 1995; 102.8:133-6.
- 8. Schramm T, Kurzl R, Schveighart C, et al: Endometrial Carcinoma and Vaginal Ultrasound Studies of The DiagnosticVolidirty. Geburtshilfe-Frauenheilkd. 1995; 55 (2):65-
- 9. Güner H, T›rafl MB, Karabacak O ve ark: Postmenopozal Kanamal› Hastalarda Vaginal Ultrasonografi ile Endometrial De¤erlendirme Diagnostik Kürtajlar› Azaltabilir mi?. T Klinik Jinekoloji Obstetrik Dergisi 1995; 5:298-302.
- 10. Osmers R, Völksen M, Schauer A: Vaginosonography for earlydetection of endometrial carcinoma.Lancet 1990;335:1569-73.
- 11. Karlsson B, Granberg S, Wiktand M, et al: TransvaginalUltrasonography of the Endometrium in Women with PostmenopausalBleeding- A NordicMulticenterStudy. Am J Obstet-Gynecol1995;172:1488-94.
- 12. fiener AB, Ekici E, Seçkin N ve ark: Postmenopozal kanama yak›nmas› ile gelen hastalarda vaginal ultrasonografi ile endometrial ölçüm ve endometrial biyopsinin karfl›laflt›r›lmas›. Jinekoloji ve Obstetride Yeni Görüfl ve Geliflmeler 1991; 3: 9-13.
- 13. Bakos 4, Smith P, Heimer G. TransvaginalUltrasonography for ‹dentifyingEndometrialPathology in PostmenopausalWomen. Maturitas 1994; 20: 181-9.
- 14. Litta P, Merlin F, Saccardi C, et al : Role of hysteroscopy with endometrialbiopsytoruleoutendometrialcancer in postmenopausalwomen with abnormaluterinebleeding. Maturitas, 50:117-123, 2005.
- 15. Fistonic I, Hodek B, Klaric P, et al: Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausalbleeding. J Clin Ultrasound, 25: 431-435, 1997.
- 16. Ferrazzi E, Torri V, Trio D, et al: Sonographic endometrial thickness: a useful test topredictatrophy in patients with postmenopausalbleeding. Ultrasound Obstet Gynecol, 7: 315-321, 1996.
- 17. Granberg S, Wikland M, Karlsson B, et al. Endometrialthickness as measuredbyendovaginalultrasonography for identifyingendometrialabnormality. Am J ObstetGynecol 1991; 164:47-52
- 18. Varner ER, Sparks JM, Cameron CD, et al. TransvaginalSonography of the Endmetrium in PostmenapausalWomen. ObstetGynecol 1991; 78:195-9.
- 19. Malinova M, Pehlivano B. Transvaginal Sonography and Endometrial Thickness in Patients with PostmenopausalUterineBleeding. EuropeanJournal of ObstetricsGynecology and Reproductive Biology. 1995; 58: 161-5.
Ayrıntılar
| Diğer ID | JA45SD26TR |
|---|---|
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2013 |
| Gönderilme Tarihi | 1 Temmuz 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 16 Sayı: 3 |