ANORMAL UTERİN KANAMASI OLAN OLGULARDA ULTRASONOGRAFİK BULGULAR ve HİSTOPATOLOJİK SONUÇLARI

Year 2021, Volume: 18 Issue: 2, 800 - 804, 01.07.2021

Özlem Özgür Gürsoy Hulusi Göktuğ Gürer Ceren Yıldız Eren

https://doi.org/10.38136/jgon.834989

Abstract

Amaç: Anormal uterin kanama (AUK) ile başvuran kadınlarda transvajinal ultrasonografik (TvUSG ) değerlendirme, histopatolojik sonuçlarla karşılaştırılarak, tanıda TvUSG’nin yerini ortaya koymaktır.
Gereçler ve Yöntem: Çalışmaya Ocak 2011- Mayıs 2020 yılları arasında AUK şikayeti ile başvurmuş, 19-86 yaş arasında, endometriyal biyopsi yapılmış 633 hasta dahil edildi. Hastaların TvUSG bulguları ile, histopatolojik sonuçları karşılaştırıldı.
Bulgular: Değerlendirilen 633 hastanın yaş ortalaması 48,3±10,3(19-86), parite ortalaması 2,1±1,2 (0-9) ve vücut kitle indeksi ortalaması 25,71±3,4 (19-32) kg/m2 saptandı. Histopatolojik sonucu normal (proliferatif ve sekretuar endometrium) kabul edilen 316 (%49,9) hastada ortalama endometriyal kalınlık (EK) 8,34±2,49 mm (2-12) bulundu. 133 (%21,0) endometriyal polip vakasında ortalama EK 13,5±0,97 mm (12-20), 52(%8,21) atipisiz endometriyal hiperplazi (Asiz EH)’de ortalama EK 15,27±3,28 mm (4-22), 102 (%16,11) atipili endometriyal hiperplazinin (Ali EH) ortalama EK’ı 18,53±3,06 mm (5-23) saptandı. Tespit edilen 30(%4,73) endometriyal adenokarsinom vakasının ortalama EK 28,87±5,09 mm (24-47) ölçüldü. One way ANOVA ve Tukey post hoc analizlerine göre EK ölçümü tanı koyma ve biyopsi endikasyonları belirleme açısından istatiksel olarak anlamlı bulundu (p<0,001). Endometriyal biyopsi endikasyonu için EK’nın premenapozda 12 mm, postmenapozda 4 mm olarak kabul etmek Pearson ki-kare testi ile anlamlı bulundu (sırası ile p<0,05 ve p<0,01).
Sonuç: AUK olan hastalarda TvUSG, uterin patolojilerin tanısını koyma ve biyopsi endikasyonunu belirlemede iyi bir görüntüleme yöntemidir.

Keywords

Anormal uterin kanama, endometriyal kalınlık, endometriyal biyopsi

THE ULTRASONOGRAPHIC FINDINGS IN ABNORMAL UTERINE BLEEDING CASES WITH THE HISTOPATHOLOGICAL RESULTS

Abstract

Aim: Compare the relation between transvaginal ultrasonographic (TvUSG ) findings with histopathology in women with abnormal uterine bleeding (AUB) and determine the role in diagnosis.
Materials and Method: 633 patients, attended between January 2011 - May 2020 with AUB, aged between 19-86 years, were included to th study. TvUSG findings were compared with histopathology.
Results: The mean age of evaluated 633 patients was 48,3±10,3(19-86), mean parity 2,1±1,2 (0-9) and mean body mass index 25,71±3,4 (19-32) kg/m2. The mean endometrial thickness of 316 (%49,9) patients with normal pathology (proliferative and secretory endometrium) was found to be 8,34±2,49 mm (2-12). The mean endometrial thickness was detected as 13.5±0.97 mm (12-20) in 133(%21.0) cases with endometrial polyp , 15.27±3.28 mm (4-22) in 52(%8,21) in patients with endometrial hyperplasia without atypia and 18.53±3.06 mm (5-23) in 102(%16.11) in cases with endometrial hyperplasia with atypia. 30 (% 4.73) endometrial adenocarcinoma cases recorded to have 28,87±5,09 mm (24-47) mean endometrial thickness. According to One way ANOVA and Tukey post hoc analysis, measuring endometrial thickness was found to be statistically significant for diagnosis and defining biopsy indications (p<0,001). Also by the analysis with Pearson ki-square test, endometrial thickness >12 mm in the premenopausal period and >4 mm in the postmenopausal period were found to be statistically significant for biopsy indications (p<0,05 and p<0,01 in order).
Conclusion: TvUSG is a primary visualising method for diagnosis of uterine pathologies and determining the endometrial biopsy indications in patients with AUB.

Keywords

Abnormal uterine bleeding, endometrial thickness, endometrial biopsy

References

• 1. Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women findings from the National Health Interview Survey, 1984 to 1992. Am J Public Health. 1996;86(2):195.
• 2. Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometriyal pathology in abnormal uterine bleeding.JObstetGynecolIndia. 2011;61(4):426-30.
• 3. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology & Obstetrics 2011;113(1):3-13.
• 4. Van den Bosch T, Vandendael A, Van Schoubroeck D,Wranz PA, Lombard CJ. Combining vaginal ultrasonography and office endometriyal sampling in the diagnosis of endometriyal disease in postmenopausal women. Obstet Gynecol 1995;85(3):349-52.
• 5. Guner H, Tiras MB, Karabacak O, Sarikaya H, Erdem M, Yildirim M. endometriyal assessment by vaginal ultrasonography might reduce endometriyal sampling in patients with postmenopausal bleeding: a prospective study. Aust N Z J Obstet Gynaecol 1996;36(2):175-78.
• 6. DorumA, Kristensen GB, Langebrekke A, Sornes T, Skaar O. Evaluation of endometriyal thickness measured by endovaginal ultrasound in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 1993;72(2):116-19.
• 7. Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177(1):102-8.
• 8. ACOG Committee Opinion No. 440: The Role of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding. Obstetrics and gynecology. 2009;114(2 Pt 1):409-11.
• 9. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557:Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol 2013;121(4):891-96.
• 10. Cote I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. AJOG. 2003;188(2):343-48.
• 11. G, Dangal. A study of endometrium in patients with abnormal uterine bleeding at Chitwan valley . Kathmandu University Medical Journal. 2003;1(2):110-12.
• 12. Ronnett BM, Zaino RJ, Ellenson LH, Kurman RT. endometriyal Carcinoma. In: Kurman RJ, editor. Blaustein’s pathology of the female genital tract. New York Springer. 2001;501-59.
• 13. Dueholm M, Jensen ML, Laursen H, Kracht P. Can the endometriyal thickness as measured by trans-vaginal sonography be used to exclude polyps or hyperplasia in pre-menopausal patients with abnormal uterine bleeding? Acta obstetricia et gynecologica Scandinavica. 2001;80(7):645-51.
• 14. Seebacher V, Schmid M, Polterauer S, Hefler-Frischmuth K, Leipold H, Concin N, et al. The presence of postmenopausal bleeding as prognostic parameter in patients with endometriyal cancer: a retrospective multicenter study. BMC cancer. 2009;9:460.
• 15. Duska LR, Garrett A, Rueda BR, Haas J, Chang Y, Fuller AF. endometriyal cancer in women 40 years old or younger. Gynecol Oncol.2001;83(2):388-93.
• 16. Lacey JV, Chia VM. endometriyal hyperplasia and the risk of progression to carcinoma. Maturitas. 2009;63(1):39-44.
• 17. Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12(8):1768-71.
• 18. Van Hanegem N, Breijer MC, Khan KS, Clark TJ, Burger MPM, Mol BWJ, et al. Diagnostic evaluation of the endometrium in postmenopausal bleeding: An evidence-based approach. Maturitas 2011;68(2):155–64.
• 19. Gredmark T, Kvint S, Havel G, Mattsson LA. Histopathological findings in women with post menopausal bleeding. British Journal of Obstetrics and Gynecology, 1995;102(2):133-36.
• 20. Bokhman Y, Tkeshelashvili VT, Vishnevsky AS, Volkova AT. Myoma uterus as a marker of oncogynecological pathology in pre- and postmenopause. Eur J. Gynaecol Oncol. 1988;9(5):355-59.
• 21. Tamay AG, Yıldırım Y, Buğday S, Koltan SO, Güvenal T, Koyuncu FM, et al. Necessity of preoperative endometriyal sampling for hysterectomies with benign indications. Cumhuriyet Medical Journal. 2010;32(4):329-33.
• 22. Emons G, Beckmann MW, Schmidt D, Mallmann P. New WHO classification of endometriyal hyperplasias. Geburtsh Frauenheilk 2015;75(2):135-36.
• 23. Ronnett B, Kurman R. Precursor lesions of endometriyal carcinoma. Der Pathologe. 2019;40(1):13-20.
• 24. .Kimura T, Kamiura S, Yamamoto T, Seino-Noda H, Ohira H, Saji F. Abnormal uterine bleeding and prognosis of endometriyal cancer. Int. J. Gynecol Obstet. 2004;85(2):145-50.
• 25. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometriyal hyperplasia.A long term study of 'untreated' hyperplasia in 170 patients . Cancer. 1985;56(2):403-12.
• 26. Clark TJ, Middleton LJ, Cooper NA, Diwakar L, Denny E, Smith P, et al. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technology Assessment. National Institute for Health Research 2015;19(61):1-194.
• 27. Kanthi JM, Remadevi C, Sumathy JM, Sharma D, Sreedhar S, Jose A. Clinical Study of endometriyal Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp. J Clin Diagnostic Res. 2016;10(6):1-4.
• 28. Ricciardi E, Vecchione A, Marci R, Shimberni M, Frega A, Maniglio P, et al. Cinical factors and malignancy in endometrial polyps, Analysis of 1027 cases. Eur J Obstetr Gynaecol Reprod Biol. 2014;183:121–24.