Paraservikal Blok Altında Yapılan Düşük Basınçlı Endometrial Biyopsilerde Başarısızlık Nedenlerinin Araştırılması

Yıl 2022, Cilt: 36 Sayı: 3, 323 - 330, 27.01.2023

Sabahattin Anıl Arı Ayşe Rabia Şenkaya İbrahim Karaca Deniz Öztekin

https://doi.org/10.18614/deutip.1161052

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

• Referans1. Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016 Mar 12;387(10023):1094–108.
• Referans2. Leclair CM, Zia JK, Doom CM, Morgan TK, Edelman AB. Pain experienced using two different methods of endometrial biopsy: a randomized controlled trial. Obstet Gynecol. 2011 Mar;117(3):636–41.
• Referans3. Sanam M, Majid MMK. Comparison the Diagnostic Value of Dilatation and Curettage Versus Endometrial Biopsy by Pipelle--a Clinical Trial. Asian Pac J Cancer Prev. 2015;16(12):4971–5.
• Referans4. Ilavarasi C, Jyothi G, Alva N. Study of the Efficacy of Pipelle Biopsy Technique to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. Journal of Mid-Life Health [Internet]. 2019 Apr 1 [cited 2022 Jul 28];10(2):75. Available from: /pmc/articles/PMC6643712/
• Referans5. Ari SA, Ari SC, Akdemir A. Effectiveness of paracervical block in endometrial sampling procedures for pain control: a randomized controlled clinical trial. Ginekologia Polska. 2022 Jun 3;
• Referans6. de Silva BY, Stewart K, Steven JD, Sathanandan M. Transvaginal ultrasound measurement of endometrial thickness and endometrial pipelle sampling as an alternative diagnostic procedure to hysteroscopy and dilatation and curettage in the management of post-menopausal bleeding. J Obstet Gynaecol. 1997;17(4):399–402.
• Referans7. Paul F, Dijkhuizen HLJ, Mol BWJ, Brö HAM, Peter A, Heintz M, et al. The Accuracy of Endometrial Sampling in the Diagnosis of Patients with Endometrial Carcinoma and Hyperplasia A Meta-Analysis. 2000;
• Referans8. Gordon SJ, Westgate J. The incidence and management of failed Pipelle sampling in a general outpatient clinic. Aust N Z J Obstet Gynaecol. 1999;39(1):115–8.
• Referans9. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. Journal of Clinical Epidemiology. 1994 Nov 1;47(11):1245–51.
• Referans10. Machado F, Moreno J, Carazo M, León J, Fiol G, Serna R. Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia. European Journal of Gynaecological Oncology. 2003 Jan 1;24(3–4):279–81.
• Referans11. Kazandi M, Okmen F, Ergenoglu AM, Yeniel AO, Zeybek B, Zekioglu O, et al. Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling. J Obstet Gynaecol. 2012 Nov;32(8):790–4.
• Referans12. Farrell T, Jones N, Owen P, Baird A. The significance of an “insufficient” Pipelle sample in the investigation of post-menopausal bleeding. Acta Obstetricia et Gynecologica Scandinavica. 1999 Sep 1;78(9):810–2.
• Referans13. Gordon SJ, Westgate J. The incidence and management of failed Pipelle sampling in a general outpatient clinic. Aust N Z J Obstet Gynaecol. 1999;39(1):115–8.
• Referans14. Ewies AAA, Shaaban KAA, Merard R, Zanetto U. Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant. J Clin Pathol. 2014;67(8):673–7.
• Referans15. Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC Fam Pract. 2018 Jul 30;19(1).
• Referans16. Adambekov S, Lopa S, Edwards RP, Bovbjerg DH, Linkov F, Donnellan N. Anxiety and Pain in Patients Undergoing Pipelle Endometrial Biopsy. Obstetrics & Gynecology. 2020 May;135:63S.
• Referans17. Elsandabesee D, Greenwood P. The performance of Pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynaecol. 2005 Jan;25(1):32–4.