Postmenopozal Kanaması Olan Hastalarda Transvajinal Ultrasonografi ve Endometriyal Biyopsi Patoloji Sonuçlarının Değerlendirilmesi

Öz

Amaç: Postmenopozal kanama endometrium kanserinin en sık semptomudur. Postmenopozal kanamalı hastaların değerlendirilmesinde transvajinal ultrasonografi (TVUSG) ilk basamak olarak kabul edilmektedir. Bu çalışmada postmenopozal kanama nedeni ile endometrial biyopsi yapılan hastaların transvajinal ultrasonografi ve histopatolojik sonuçlarını değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Çalışmaya postmenopozal kanama nedeni ile endometrial biyopsi yapılan 40 hasta dahil edildi. Hastaların transvajinal ultrasonografi bulguları ve endometrial biyopsi sonuçları karşılaştırıldı.
Bulgular: Hastaların %7,5’inde kanser saptanırken, en sık endometrial polip (%25), atrofik endometrium (%25) ve yetersiz materyal (%22,5) saptandı. Endometrial polip, TVUSG ile endometrial kalınlığı >5 mm ölçülen hastalarda anlamlı olarak daha fazla saptanırken (p=0.003), yetersiz materyal endometrial kalınlığın ≤5 mm ölçüldüğü hasta grubunda anlamlı olarak daha fazla saptandı (p=0.018). TVUSG’de ölçülen endometrium çift duvar kalınlığı sınırı 5 mm’nin üzeri olarak alınırsa, endometrium kanseri için sensitivite %100, spesifitesi %43,2, negatif prediktif değer %100, pozitif prediktif değer %12,5 olarak saptandı.
Sonuç: TVUSG postmenopozal kanamalı hastaların değerlendirilmesinde yol göstericidir. Fakat endometrium kanserini dışlamak için endometrial örneklemenin önemi unutulmamalıdır.

Anahtar Kelimeler

• postmenopoz,
• uterus kanaması
• ultrasonografi

Evaluation of Transvaginal Ultrasonography and Endometrial Biopsy Pathology Results in Patients with Postmenopausal Hemorrhage

Öz

Aim: Postmenopausal bleeding is the most common symptom of endometrial cancer. Transvaginal ultrasound is considered as the first step in the evaluation of patients with postmenopausal bleeding. In this study, we aimed to evaluate the transvaginal ultrasonography and histopathological results of patients who underwent endometrial biopsy for postmenopausal bleeding.
Materials and Methods: Forty patients who underwent endometrial biopsy due to postmenopausal bleeding were included in the study. Transvaginal ultrasonography findings and endometrial biopsy results of the patients were compared.
Results: While cancer was detected in 7.5% of the patients, the most common ones were endometrial polyp (25%), atrophic endometrium (25%) and insufficient material (22.5%). Endometrial polyp was significantly higher in patients whose endometrial thickness was measured> 5 mm by TVUSG (p = 0.003), while insufficient material was significantly higher in the patient group with endometrial thickness ≤5 mm (p = 0.018). If the endometrial double wall thickness limit measured in TVUSG is taken as above 5 mm, the sensitivity for endometrial cancer was found to be 100%, specificity 43.2%, negative predictive value 100%, and positive predictive value 12.5%.
Conclusion: TVUSG guides in the evaluation of patients with postmenopausal bleeding. However, the importance of endometrial sampling should not be forgotten to exclude endometrial cancer.

Anahtar Kelimeler

• Postmenopause
• uterine bleeding
• ultrasonography

Kaynakça

1. 1. Epstein E, Valentin L. Managing women with post-menopausal bleeding. Best Pract Res Clin Obstet Gy¬naecol. 2004;18:125–43.
2. 2. ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018 May;131(5):e124-e129.
3. 3. Goldstein SR, Nachtigall M, Snyder JR, Nachtigall L. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol. 1990;163:119–23.
4. 4. Varner RE, Sparks JM, Cameron CD, Roberts LL, Soong SJ. Transvaginal sonography of the endometrium in post¬menopausal women. Obstet Gynecol. 1991;78:195–9.
5. 5. Granberg S, Wikland M, Karlsson B, Norstrom A, Friberg LG. Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol. 1991;164:47–52.
6. 6. Aker SŞ, Yüce T, Acar D, Atabekoğlu CS. Anormal Uterin Kanaması olan Kadınlarda Endometrial Örnekleme Sonuçları: 765 Vakanın Retrospektif Analizi. Cukurova Medical Journal. 2015;40:306-10.
7. 7. Dadalı Y, Turan A, Aydın B, Çiner OA, Dilli A, Koşar P. Postmenopozal kanaması olan hastalarda transvajinal ultrasonografi ile endometriumun değerlendirilmesi ve histopatoloji sonuçları ile karşılaştırılması. S.D.Ü Sağlık Bilimleri Enstitüsü Dergisi. 2013;4(2):63-69.
8. 8. Williams AR, Brechin S, Porter AJL, Warner P, Critchley HOD. Factors affecting adequacy of pipelle and Tao Brush endometrial sampling. BJOG. 2008;115:1028–36.

9. 9. Bakour SH, Khan KS, Gupta JK. Controlled analy¬sis of factors associated with insufficient sample on out¬patient endometrial biopsy. BJOG. 2000;107:1312–4.
10. 10. Dreisler E, Stampe-Sorensen S, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol. 2009;33(1):102-8.
11. 11. Demirtaş Ö, Yeniel Ö, Ergenoğlu M, Demirtaş G, Aşkar N. Klinik olarak endometrial polip tanısı alan olguların retrospektif analizi. Ege Tıp Dergisi. 2012;51(4):239-244.
12. 12. Gredmark T, Kvint S, Havel G, Mattsson LA.Histopathological findings in women with postmenopausal bleeding. Br J Obstet Gynaecol. 1995 Feb;102(2):133-6.
13. 13. Kazerooni T, Ghaffarpasand F, Mosalaei A, Kazerooni Y. The value of transvaginal ultrasonography in the endometrial evaluation of breast cancer patients using tamoxifen. Med Princ Pract. 2010;19(3):222-7.
14. 14. Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol. 1995;172:1488-94.
15. 15. Botsis D, Kassanos D, Pyrgiotis E, Zourlas PA. Vaginal sonography of the endometrium in postmenopausal women. Clin Exp Obstet Gynecol. 1992;19:189-92.
16. 16. Renaud MC, Le T, Bentley J, Farrell S, Fortier MP, Giede C et al. Epidemiology and investigations for suspected endometrial cancer. J Obstet Gynaecol Can. 2013;35:380–3.
17. 17. Scottish Intercollegiate Guidelines Network. Investigation of Post-Menopausal Bleeding. (SIGN Guideline No 61), 2002.
18. 18. Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of post¬menopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol. 2003;188:401–8.
19. 19. Gupta JK, Chien PFW, Voit D, Clark TJ, Khan KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstet Gynaecol Scand. 2002;81:799–816.
20. 20. Wong AS, Lao TT, Cheung CW, Yeung SW, Fan HL, Ng PS et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG. 2016;123:439–46.