POSTMENOPOZAL VAJİNAL KANAMALI OLGULARDA TRANSVAJİNAL ULTRASONOGRAFİ VE BİOPSİ SONUÇLARININ KARŞILAŞTIRILMASI

Abstract

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.

Keywords

• Postmenopozal Kanama, Endometrial Kal›nl›k, Transvajinalsonografi.

Abstract

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

Keywords

• Postmenopausal Bleeding, Endometrial Thickness, Transvaginal Ultrasonography.

References

1. 1. Rodger FE, Walker J, Critchley HOD: Investigating the woman with postmenopausalbleeding. TrendsIn UGSH, 10:1-4 , 2005.
2. 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. 3. Oriel KA, Schrager S: Abnormaluterinebleeding. AmericanFamilyPhysician, 60:1371-1382, 1999.
4. 4. Hurd WW. AbnormalBleeding. InBerek JS, Adashi EY, Hillard PA. Menopause. Novak’sGynecology. Pennsylvania. Williams &WilkinsCompany, 1996.
5. 5. Loverro G, Bettocchi S, Cormio G, et al. Transvaginalsonographyandhysteroscopy in postmenopausaluterinebleeding. Maturitas 1999;33:139-44.
6. 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. 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. 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. 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. 10. Osmers R, Völksen M, Schauer A: Vaginosonography for earlydetection of endometrial carcinoma.Lancet 1990;335:1569-73.
11. 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. 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. 13. Bakos 4, Smith P, Heimer G. TransvaginalUltrasonography for ‹dentifyingEndometrialPathology in PostmenopausalWomen. Maturitas 1994; 20: 181-9.
14. 14. Litta P, Merlin F, Saccardi C, et al : Role of hysteroscopy with endometrialbiopsytoruleoutendometrialcancer in postmenopausalwomen with abnormaluterinebleeding. Maturitas, 50:117-123, 2005.
15. 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. 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. 17. Granberg S, Wikland M, Karlsson B, et al. Endometrialthickness as measuredbyendovaginalultrasonography for identifyingendometrialabnormality. Am J ObstetGynecol 1991; 164:47-52
18. 18. Varner ER, Sparks JM, Cameron CD, et al. TransvaginalSonography of the Endmetrium in PostmenapausalWomen. ObstetGynecol 1991; 78:195-9.
19. 19. Malinova M, Pehlivano B. Transvaginal Sonography and Endometrial Thickness in Patients with PostmenopausalUterineBleeding. EuropeanJournal of ObstetricsGynecology and Reproductive Biology. 1995; 58: 161-5.