Endometrium Kanserinde Servikal Kanal Tutulumunu Belirlemede Fraksiyoneküretaj ve LEEP’in Etkinliğinin Karşılaştırılması

Yıl 2024, , 240 - 245, 29.08.2024

Senem Alkan Akalın , Mehmet Gökçü , Yusuf Yıldırım , Veysel Toprak , Mert Ulaş Barut

https://doi.org/10.35440/hutfd.1374643

Öz

Amaç: Bu çalışmanın amacı, endometrium kanserinde servikal tutulumun preoperatif değer-lendirilmesinde LEEP(Loop Electrosurgical Excision Procedure) işleminin etkinliğinin saptanması ve yapılacak olan cerrahi prosedürün planlanmasına katkısını değerlendirmektir.
Materyal ve metod: Prospektif olarak incelenen ve histopatolojik sonuçları endometrial kanserle uyumlu gelen 75 hasta endoservikal kürejaj ve LEEP yapılmak üzere iki guruba ayrıldı. tüm hastalara basit histerektomi/radikal histerktomi ve pelvik, paraaortik lenf nodu örnekleme, omentektomi, sitoloji alımını içeren cerrahi evreleme prosedürü uygulandı. Evreleme FIGO 2009 cerrahi evreleme sistemine göre yapıldı. Hastaların preoperatif uygulanan ECC ve LEEP prosedürlerinden elde edilen histopatolojik bulgular, operasyon patolojileriyle karşılaştırılarak, servikal tutulumu belirlemedeki doğruluk oranları, sensitivite ve spesivitelerinin belirlenmesi amaçlandı.
Bulgular: Endoservikal küretaj örneklerinin patoloji sonuçlarıyla operasyon patolojileri karşılaştırıldı-ğında istatiksel olarak anlamlı olduğu, fakat doğruluk oranının 58.7% olduğu belirlendi. Loop Electro-surgical Excision procedure uygulanan Hastalardan alınan örnekler ameliyat patolojileriyle karşılaştı-rıldığında istatiksel olarak anlamlı olduğu saptandı ve doğruluk oranının %93.5 olduğu görül-dü(p=0.037).
Sonuç: LEEP işlemi ile servikal tutulumu belirleme, sıklıkla uygulanmakta olan endoservikal küretaja spesivite, pozitif prediktivite ve doğruluk oranı açısından üstündür.

Anahtar Kelimeler

Endometrial kanser, Endoservikalküreaj, LEEP

Comparison of the Efficacy of Fractionated Curettage and LEEP in Determin-ing Cervical Canal Involment in Endometrial Cancer

Öz

Background: The aim of this study is to determine the effectiveness of the LEEP (Loop Electrosurgical Excision Procedure) procedure in the preoperative evaluation of cervical involvement in endomet-rial cancer and to evaluate its contribution to the planning of the surgical procedure.
Materials and Methods: 75 patients who were examined prospectively and whose histopathological results were compatible with endometrial cancer were divided into two groups to undergo endo-cervical curettage and LEEP. All patients underwent simple hysterectomy/radical hysterectomy and a surgical staging procedure including pelvic, para-aortic lymph node sampling, omentectomy, and cytology collection. Staging was done according to the FIGO 2009 surgical staging system. The aim was to determine the accuracy rates, sensitivity and specificity in determining cervical involvement by comparing the histopathological findings obtained from the preoperative ECC (Endecervical Cu-rettage) and LEEP procedures of the patients with the operation pathologies.
Results: When the pathology results of endocervical curettage samples were compared with the operation pathologies, it was determined that it was statistically significant, but the accuracy rate was 58.7%. When the samples taken from the patients who underwent the LoopElectrosurgicalExci-sion procedure were compared with the surgical pathologies, it was found to be statistically signifi-cant and the accuracy rate was found to be 93.5% (p = 0.037).
Conclusions: Determining cervical involvement with the LEEP procedure is superior to the frequ-ently applied endocervical curettage in terms of specificity, positive predictivity and accuracy.

Kaynakça

• 1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277-300. doi: 10.3322/caac.20073. Epub 2010 Jul 7. Erratum in: CA Can-cer J Clin. 2011;61(2):133-4.
• 2. Amant F, Moerman P, Neven P, Timmerman D, Van Lim-bergen E, Vergote I. Endometrial cancer. Lancet. 2005;366(9484):491-505.
• 3. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silver-berg SG, Miller A, Blessing JA. Surgical staging in endo-metrial cancer: clinical-pathologic findings of a prospecti-ve study. Obstet Gynecol. 1984;63(6):825-32.
• 4. DiSaia PJ, Creasman WT, Boronow RC, Blessing JA. Risk factors and recurrent patterns in Stage I endometrial can-cer. Am J Obstet Gynecol. 1985;151(8):1009-15.
• 5. Buldanlı N, Uslu T, Saygılı U, Çağlıyan E, Pırpanlar S. JİNEKOLOJİK Tümörlerde Sağkalım ve Buna Etki Eden Fak-törler: Dejog Serisi. Türk Jinekolojik Onkoloji Dergisi. 2006;9:67–74.
• 6. Yardım T,Yüce M,Özyılmaz F,Yorulmaz F,Kurtul M,Sayın C. Endometrium kanseri olgularımızda sağkalım süresine et-ki eden prognostik faktörler ve klinik deneyimimiz. 1999;9: 141 - 148.
• 7. Morimura Y, Soeda S, Hashimoto T, Takano Y, Ohwada M, Yamada H, Yanagida K, Sato A. The value of pre-operative diagnostic procedures for cervical involvement in uterine corpus carcinoma. Fukushima J Med Sci. 2000;46(1-2):1-11.
• 8. Rubin SC, Hoskins WJ, Saigo PE, Nori D, Mychalczak B, Chapman D, Lewis JL Jr. Management of endometrial adenocarcinoma with cervical involvement. Gynecol On-col. 1992;45(3):294-8.
• 9. Toki T, Oka K, Nakayama K, Oguchi O, Fujii S. A compara-tive study of pre-operative procedures to assess cervical invasion by endometrial carcinoma. Br J Obstet Gynaecol. 1998 May;105(5):512-6.
• 10. Cosa-NZ-UK Endometrial Cancer Study Groups. Pelvic lymphadenectomy in high risk endometrial cancer. Int J Gynecol Cancer. 1996,6:102-107.
• 11. J. S. Berek and N. F. Hacker, “Practical Gynecologic Onco-logy”, 4th Edition, Williams & Wilkins, Philadelphia, 2005.
• 12. Mao Y, Wan X, Chen Y, Lv W, Xie X. Evaluation of the accuracy of intra-operative gross examination for the sur-gical management of endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2008 Dec;141(2):179-82.
• 13. Nagar H, Dobbs S, McClelland HR, Price J, McCluggage WG, Grey A. The diagnostic accuracy of magnetic reso-nance imaging in detecting cervical involvement in endo-metrial cancer. Gynecol Oncol. 2006;103(2):431- 4.
• 14. Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH. Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer. 2007;17(1):188-96.
• 15. Yahata T, Aoki Y, Tanaka K. Prediction of myometrial invasion in patients with endometrial carcinoma: compa-rison of magnetic resonance imaging, transvaginal ultra-sonography, and gross visual inspection. Eur J Gynaecol Oncol. 2007;28(3):193-5.
• 16. Vasconcelos C, Félix A, Cunha TM. Preoperative assess-ment of deep myometrial and cervical invasion in endo-metrial carcinoma: comparison of magnetic resonance imaging and histopathologic evaluation. J Obstet Gyna-ecol. 2007 Jan;27(1):65-70.
• 17. Trimble EL, Jones HW 3rd. Management of stage II en-dometrial adenocarcinoma. Obstet Gynecol. 1988;71(3 Pt 1):323-6.
• 18. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987 Oct 15;60(8 Suppl):2035-41.
• 19. Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE. Relationship between surgi-cal-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic On-cology Group study. Gynecol Oncol. 1991 Jan;40(1):55-65.
• 20. Turan T, Gündoğdu B, Karabük E, Sarıcı S, Boran N, Tulu-nay G, Özfuttu A, Köse MF. Endometrium Kanserinde Lenf Nodu Metastazını Belirleyen Faktörler. Türk Jinekolojik Onkoloji Dergisi. 2010;13(3):61-7.
• 21. Mariani A, Keeney GL, Aletti G, Webb MJ, Haddock MG, Podratz KC. Endometrial carcinoma: paraaortic dissemina-tion. Gynecol Oncol. 2004 Mar;92(3):833-8.
• 22. Lee TS, Kim JW, Kim DY, Kim YT, Lee KH, Kim BG, McMe-ekin DS. Necessity of radical hysterectomy for endomet-rial cancer patients with cervical invasion. J Korean Med Sci. 2010 Apr;25(4):552-6. doi: 10.3346/jkms.2010.25.4.552.
• 23. Patsner B, Mann WJ, Cohen H, Loesch M. Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma. Am J Obstet Gyne-col. 1988;158(2):399-402.
• 24. Hanson MB, van Nagell JR Jr, Powell DE, Donaldson ES, Gallion H, Merhige M, Pavlik EJ. The prognostic signifi-cance of lymph-vascular space invasion in stage I endo-metrial cancer. Cancer. 1985;55(8):1753-7.