Paraservikal Blok Altında Yapılan Düşük Basınçlı Endometrial Biyopsilerde Başarısızlık Nedenlerinin Araştırılması

Öz

Amaç Ofis şartlarında uygulanması sebebi ile popüler hale gelen pipelle endometrial biyopsi sonrası histopatolojik tanı için yeterli materyal elde edilememesi tekniğin olumsuz yönü olarak öne çıkmaktadır. Çalışmanın amacı pipelle biyopsi başarısızlığının nedenlerini ortaya koymak olarak belirlenmiştir. Gereç ve Yöntem İzmir Bakırçay Üniversitesi Kadın Hastalıkları ve Doğum Anabilim Dalı’nda 2019-2022 yılları arasında pipelle biopsi işlemi uygulanan olgular planlanan retrospektif çalışmaya dahil edilmiştir. Belirlenen olguların yaş, boy, kilo, vücut kitle endeksi, gebelik ve doğum sayıları ile doğum tipleri, işlemin tıbbi gerekçesi, işlem öncesi endometrial duvar kalınlıkları, ek hastalıkları, biyopsi başarısızlık nedenleri kaydedilmiştir. Bulgular Çalışmaya 317 hasta alınmıştır. Olguların median yaşı 45 (min: 35 maks:88) olarak saptanmıştır. Ortalama VKI 25,06 (±3,7) olarak bulunmuştur. Materyal alınabilen 315 hastanın 266’sına (%84,4) histopatolojik tanı konulmuştur. 49 (%15,6) hastaya materyal yetersizliği nedeni ile histopatolojik tanı konulamamıştır. Tek değişkenli lojistik regresyon analizinde ileri yaş (OR 0,83, %95 CI 0,79-0,88, p=0,001), PMVK endikasyonu (OR 20,8, %95 CI 10-43,4, p=0,001), endometrial kalınlığın <7,5 mm olması (OR 1,34, %95 CI 1,38-1,51, p=0,001), CCI skoru yüksekliğinin (OR 0,25, %95 CI 0,16-0,40, p=0,001) biyopsi başarısızlığı ile istatistiksel olarak anlamlı ilişkisi olduğu gösterilmiştir. Yapılan basamaklı regresyon analiz sonucu yalnızca ileri yaş (OR 0,9, %95 CI 0,85-0,96, p=0,001), biyopsi endikasyonunun PMVK olması (OR 18, %95 CI 6,04-53,6, p<0,000) ve endometrial kalınlığın <7,5 mm olmasının (OR 1,5 %95 CI 1,2-1,7, p<0,000) biyopsi başarısızlığı riskini anlamlı ölçüde arttırdığı gösterilmiştir. Sonuç Paraservikal blok altında yapılan pipelle endometrial biyopsilerde ileri yaş, endikasyonun PMVK olması ve endometrial kalınlığın <7,5 mm olması yetersiz örnekleme nedenli başarısızlık riskini arttırmaktadır.

Anahtar Kelimeler

• Endometrial biyopsi
• paraservikal blok
• örneklem yetersizliği pipelle biyopsi
• pipelle biyopsi

Risk Factors of Low-Pressure Endometrial Biopsies Failures Under Paracervical Block

Öz

Aim The inability to obtain sufficient material for histopathological diagnosis after endometrial biopsy with pipelle cannula stands out as the negative aspect of the technique. The aim of the study was determined to reveal the risk factors for pipelle biopsy failure. Materials and Methods The cases who underwent biopsy with pipelle between 2019-2022 in İzmir Bakircay University, Department of Obstetrics and Gynecology were included in the planned retrospective study. Age, height, weight, body mass index, number of pregnancies and births, types of delivery, indication for the procedure, endometrial wall thickness before the procedure, comorbidities, and causes of biopsy failure were recorded. Results A total of 317 patients were included in the study. The median age of the cases was 45 (min: 35, max: 88). The mean BMI was found as 25.06 (±3.7). Pipelle biopsy failed in 49 (15.6%) patients due to lack of material. Advanced age (OR 0.83, 95% CI 0.79-0.88, p=0.001), post-menopausal bleeding as an indication (OR 20.8, 95% CI 10-43.4, p=0.001), endometrial thickness <7.5 mm (OR 1.34, 95% CI 1.38-1.51, p=0.001), high CCI score (OR 0.25, 95% CI 0.16-0.40) , p=0.001) was shown to be statistically significantly associated with biopsy failure in univariate logistic regression analysis. The stepwise regression analysis result was only advanced age (OR 0.9, 95% CI 0.85-0.96, p=0.001), post-menopausal bleeding as an indication (OR 18, 95% CI 6.04-53.6, p <0.000) and endometrial thickness <7.5 mm (OR 1.5 95% CI 1.2-1.7, p<0.000) have been shown to significantly increase the risk of biopsy failure. Conclusion Advanced age, post-menopausal bleeding as an indication and endometrial thickness <7.5 mm increase the risk of failure due to insufficient sampling in pipelle endometrial biopsies performed under paracervical block.

Anahtar Kelimeler

• Endometrial biopsy
• paracervical block
• pipelle biopsy
• sample failure

Kaynakça

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