The evaluation of the endometrium with transvaginal ultrasound in the postmenoposal patients with vaginal bleeding and comparison of the ultrasonographic diagnosis with the report of histopathologic analysis

Abstract

The evaluation of the endometrium with Transvaginal Ultrasound in the the postmenoposal patients with vaginal bleeding and comparison of the ultrasonographic diagnosis with the report of histopathologic analysis Aim: Endometrial carcinoma is a female genital cancer which is the most prevalent disease in developed countries. There has not been any scanning program developed for the endometrial carcinoma. This causes delay in diagnosis and treatment in asymptomatic patients. This study was conducted with the aim of examinining the reliabilty of transvaginal ultrasonograpy in the evaluation of endometrial pathologies. Material-Method: In the study, transvaginal ultrasonograpy was conducted on 52 patients who were admitted to our hospital with postmenopausal bleeding complaints, and images obtained were compared with the probe curettage results. Findings: Endometrial carcinoma was detected in 5 of the 52 patients in our study. Median endometrial thickness in the endometrial carcinoma group was 20,6 mm in the transvaginal ultrasonography where endometrial thicness is accepted as 15,3 mm in pathologic group (endometrial carcinoma, endometrial polyp) and it was found 4,4 mm in the benign group (atrophic endometrial, insufficient material, prolipherative/secretory endometrial). The cutt-off value was taken as 5 mm for endometrial thickness in the differentiation of endometrial pathologies by transvaginal ultrasonography. Sensitivity of transvaginal ultrasonography in the detection of pathologic endometrial is 100%, specifity 79,4%, positive predictive value 71% and negative predictive value is 100%. Therefore, the risk of finding endometrial pathology as the reason for the bleeding in patients whose endometrail thickness is found 5 mm or less by transvaginal ultrasonography would be very low. Results: Transvaginal ultrasonography could be used as ascreening modality in women with bleeding, and could select the patients who need further invasive procedure. However, as it is not possible to distinguish endometrial benign and malign lesions by ultrasonography, the standard D&C should keep its place as the diagnostic procedure in patients with postmenopausal bleeding. Keywords: postmenopausal bleeding, endometrial thicness, Transvaginal ultrasonography

Keywords

• postmenopausal bleeding, endometrial thicness, Transvaginal ultrasonography

Postmenopozal kanaması olan hastalarda transvajinal ultrasonografi ile endometriyumun değerlendirilmesi ve ön tanıların endometriyal histopatoloji sonuçları ile karşılaştırılması

Abstract

Amaç: Endometriyum karsinomu, gelişmiş ülkelerde en sık rastlanan kadın genital kanseridir. Endometriyum karsinomu için bir tarama programı geliştirilmemiştir. Bu nedenle asemptomatik hastalarda tanı ve tedavi gecikmektedir. Bu çalışma transvajinal ultrasonografinin endometriyum patolojilerinin değerlendirmesindeki güvenilirliğini araştırmak amacıyla yapılmıştır. Gereç Yöntem: Bu araştırmada postmenopozal kanama (PMK) şikayeti ile başvuran toplam 52 hastaya transvajinal ultrasonografi (TVUS) yapılmış, probe küretaj sonuçları ile karşılaştırılmıştır. Bulgular: Bizim çalışmamızdaki 52 hastanın 5'inde endometriyum karsinomu tespit edilmiştir. Endometriyum karsinomu grubunda ortalama endometriyum kalınlığı TVUS'de 20,6mm iken patolojik grupta (endometriyal hiperplazi ve endometriyal karsinom) endometriyum kalınlığı 15,3mm, benign grupta ise (atrofik endometriyum, yetersiz materyal, proliferatif/sekretuar endometriyum) 4,4 mm olarak bulunmuştur. Transvajinal ultrasonografi ile endometriyal patolojilerin ayırt edilesinde endometriyum kalınlığı için cutt-off değeri 5mm olarak alınmıştır. Bu değere göre PMK'lı hastalarda endometriyal patolojilerin saptanmasında sensitivite %100, spesivitesi %79,4, pozitif prediktif değeri %71 ve negatif prediktif değeri ise %100'dür. Buna bağlı olarak TVUS ile endometriyum kalınlığı 5 mm veya altında bulunan PMK kadınlarda kanamanın nedeni olarak endometriyal bir patoloji bulunması riski çok düşüktür. Sonuç: TVUS, kanaması olan kadınlarda bir tarama metodu olarak kullanılabilir ve ileri invaziv girişimlere gerek duyulan hastaları seçebilir. Ancak sonografik olarak endometriyal benign ve malign lezyonları ayırt etmek mümkün olmadığından postmenopozal kanamalı hastalarda dilatasyon ve küretaj(D&C) standart diagnostik prosedür olarak yerini korumalıdır. Anahtar kelimeler: Postmenopozal kanama, Endometriyum kalınlığı, Transvajinal ultrasonografi

Keywords

• Anahtar Endometrium kalınlığı, Transvajinal ultrasonografikelimeler: Postmenopozal kanama

References

1. Riddick DH. Menstrüel fonksiyon bozuklukları. In Scot Jr, DiSaia PJ, Hammond CB(Eds):Obstetrik ve Jinekoloji. İstanbul Alendar Ofset, 1992
2. Burbos N, Musonda P, Giarenis I, et al. Prediciting the risk of endometrial cancer in postmenopausal women prnesenting with vaginal bleeding: the Norwich DEFAB risk assessment tool. Br J Cancer 2010; 102: 1201–12066
3. Scierra GD. Endometrial hyperplasia: Diagnosis and Management, 1991;4–12–1
4. Hajj N.J. Evans J.W. Clinical Post Reproductive Gynecology. 1997;13–191
5. Parker SL, Tong T, Bolden ES, Wingo PA. Cancer Staticticss 1996. Cancer J Clin 45:5–28
6. Osmers R, Völksen M, Schauer A. Vaginosonography for early dedection of endometrial carcinoma. Lancet 335;1969
7. Thin–Chiu LI, Nuttal L, Klendzeris L et al. How well does ultrasonographic measurement of endometrial thickness predict the result of histological datting. Hum Rep Med;1: 1992.
8. Nasri MN. The role of vaginal scan in measurament of endometrial thickness in postmenopausal women. Br J Gynecol 1991;9898:470–75

9. Varner RE, Sparks JM, Cameron CD. Transvaginal sonography of the endometrium in postmenoupausal women. Obstet Gynecol 1991;782:195–9
10. Malpani A. Singer J. Value of Endometrial thickness in ultrasonography diagnosis and clinical significance. J Clin Ultrasound 1990;18:173
11. Seith G, Mats W, Bengt K, et al. Endometrial thickness as measuret by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet and Gynecol 1991;164:47–52
12. Dorum A, Kristensen GB, Lon GA, et al. Evaluation of endometrial thickness measuret by endovaginal ultrasond in women with posmenopusal bleeding. Acta Obstet And Gynecol 1993;72:116–9
13. Bcritt G, Grangberg MD. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding. Is it always necessary to perform on endometrial biopsy. Am j of Obstet and Gynecol 2000;182:509–15
14. Wikland M, Grangber S. Endometrial thickness as measuret by endovaginal ultrasonography for identifying endometrial abnormality: A Nordic multicenterstudy. Am J Obstet Gynecol 1995;172:1488–94
15. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 426: The Role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol 2009;113:426–4
16. Yumru A, Bozkurt M, Çaylan(Canıtez) Ö. Postmenopozal kanamalı vakalarda transvajinal sonografi, tanısal histeroskopi ve histeroskopi sonrası biyopsinin değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 30 (2) 97–101, 2004
17. Rudelstorger R, Bernocshek G. Vaginosonography and its diagnostic value in patient with postmenopausal bleeding. Arch Gynecol and Obstet 1990;248:37–44.