Asemptomatik Postmenopozal Endometrial Kalınlık Artışında Yönetim

Year 2018, Volume: 21 Issue: 2, 8 - 16, 15.03.2020

Rauf Melekoğlu , Ercan Yılmaz

Abstract

ÖZET:

Transvajinal ultrasonografinin klinik kullanıma girmesinden sonra birçok çalışma postmenopozal hastalarda endometriyum kanserinin erken tanısı için transvajinal ultrasonografinin etkin bir tarama metodu olarak önemini değerlendirmiştir. Ancak, postmenopozal kadınlarda rastlantısal olarak tanımlanan artmış endometriyal kalınlığın yönetimi henüz standardize edilmemiştir. Klinik pratikte bu insidental bulgunun saptanması çok sayıda biyopsi yapılmasına yol açmaktadır. Postmenopozal kanaması olan hastalarda transvajinal ultrasonografinin ilk değerlendirme için uygun olduğu, endometrium kalınlığının 4mm’nin altı olduğu değerlerde endometrium kanseri için negatif prediktif değerinin %99’un üstünde olduğu bildirilmiştir. Bununla birlikte kanaması olmayan postmenopozal hastalarda transvajinal ultrasonografinin endometrium kanseri taraması için uygun bir tarama aracı olmadığı, bu hasta grubunda hasta özellikleri ve risk faktörlerine göre bireyselleştirilmiş değerlendirme yapılması gerektiği gösterilmiştir. Tamoksifen kullanan kadınların endometrium kanseri erken tanısı için rutin endometrial kalınlık ölçümü ile taranması gereksiz invaziv işlemlere ve yüksek maliyetli tanısal prosedürlere neden olabileceği için önerilmemektedir. Postmenopozal asemptomatik polip saptanan hastaların tamamında cerrahi gereklilik bulunmamakla birlikte asemptomatik polip varlığında yönetim polipin çapı, hasta yaşı ve diğer endometrium kanseri risk faktörlerinin durumuna göre belirlenmesi uygundur. Tek başına asemptomatik postmenopozal endometrial sıvı koleksiyonunun varlığı ise daha ileri tanısal inceleme gerektirmemekte bu hastaların bilinen endometrium kanseri risk faktörlerinin varlığı ile birlikte değerlendirilmesi daha uygun gözükmektedir.

ABSTRACT

            Since the use of transvaginal ultrasonography in clinical practice, many studies have evaluated the importance of transvaginal ultrasonography as an effective screening method for the early diagnosis of endometrium cancer in postmenopausal patients. However, the management of increased endometrial thickness, which is coincidentally defined in asymptomatic postmenopausal women, has not been standardized yet. In clinical practice, the detection of this incidental finding leads to a large number of biopsies. In patients with postmenopausal bleeding, it was reported that transvaginal ultrasonography is suitable for initial evaluation and that the endometrial thickness below 4mm has more than 99% negative predictive value for endometrium cancer. However, in postmenopausal women without vaginal bleeding, it is suggested that transvaginal ultrasonography is not a suitable screening tool for endometrial cancer screening, and that individualized evaluation should be performed according to patient characteristics and risk factors in this group of patients. Endometrial thickness measurement by transvaginal ultrasonography is not recommended for women using tamoxifen because routine screening for endometrial thickness measurement for early endometrial cancer detection may result in unnecessary invasive procedures and costly diagnostic procedures. Although postmenopausal asymptomatic polyps are not required for surgery, management of asymptomatic polyps based on polyp diameter, patient age, and other endometrium cancer risk factors is appropriate. The presence of asymptomatic postmenopausal endometrial fluid collection alone does not require further diagnostic evaluation, and it is more appropriate to evaluate these patients with the presence of known endometrial cancer risk factors. 

Keywords

endometriyum, endometrial hiperplazi, endemetriyum kanseri, hormon replasman tedavisi, tamoksifen, ultrasonografi

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