POSTMENOPOZAL UTERUS KANAMALARINDA TRANSVAJİNAL ULTRASONOGRAFİ, SONOHİSTEROGRAFİ VE HİSTEROSKOPİ KULLANIMININ TANISAL DEĞERİ

Öz

Amaç: Postmenopozal kanamalarda transvaginal ultrasonography (TVS) sonohisterografi ve histereskopinin tanı koymada yararlı olup olmadığının araştırılması. Gereç ve yöntem: Prospektif olarak yapılan bu çalışmada 50 hastaya transvajinal ultrasonografi, sonohisterografi ve histeroskopi uygulanmıştır. Tüm tanılar histeroskopi sonrasında yapılan biyopsi sonuçlarıyla karşılaştırılmıştır. Bulgular: Tüm endometrial lezyonlar gözönüne alındığında endometriumda patoloji saptamada sensitivitesi TVS, sonohisterografi ve histeroskopi için % 100, spesifisite TVS ve sonohisterografi için % 76, histeroskopi için % 100, TVS ve sonohisterografi için % 89, histeroskopi için % 100 bulunmuştur. Sonuç: Sonohisterografi en az TVS kadar postmenopozal kanamalarda endometrial patolojilerde değerlidir.

Anahtar Kelimeler

• Postmenopozal kanama, histeroskopi, sonohisterografi, transvaginal ultrasonografi

Kaynakça

1. Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol 2000;21:180-183.
2. Bagis T, Kiliçdag EB, Tarim E, Çetintafl S. Endometrial patolojilerin saptanmasinda salin sonohisterografinin yeri. Türkiye Klinikleri Jinekoloji Obstetrik Dergisi 2003;13:36-40.
3. Bakour SH, Dwarakanath LS, Khan KS, Newton JR, Gupta JK. The diagnostic accuracy of outpatient miniature hysteroscopy in predicting premalignant and malignant endometrial lesions. Acta Obstet Gynecol Scand. 1999 ;78:447-451.
4. Bernard JP, Lecuru F, Darles C, Robin F, de Bievre P, Taurelle R. Saline contrast sonohysterography as first line investigation for women with uterine bleeding. Ultrasound Obstet Gynecol 1997;10:121-125.
5. Cohen JR, Luxman D, Sagi J, Yovel I, Wolman I, David MP. Sonohysterography for distinguishing endometrial thickening from endometrial polips in postmenopausal bleeding. Ultrasound Obstet Gynecol 1994;4:227-230.
6. Creasman WT. Endometrial cancer: incidence, prognostic factors, diagnosis, and treatment. Semin Oncol 1997;24:140150.
7. Epstein E, Ramirez A, Skoog L, Valentin L. Transvaginal sonography, saline contrast sonography and hysteroscopy for intervention of women with postmenopausal bleeding and endometrium >5mm. Ultrasound Obstet Gynecol 2001;18:157-162.
8. Epstein E, Ramirez A, Skoog L, Valentin L. Dilatation and curretage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scan 2001;80:1131-1136.

9. Ferry J, Farnsworth A, Webster M, Wren B. The efficacy of endometrial biopsy in detecting endometrial cancer. Aust N Z J Obstet Gynaecol 1993;33:76-78.
10. Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage: a rewiew of 276 cases. Am J Obstet Gynecol 1988;158:489-492.
11. Grimes DA. Diagnostic dilatation and curettage: a reapraisal. Am J Obstet Gynecol 1982;142:1-6.
12. Loverro G, Bettocchi S, Cormio G, Nicolardi V, Greco P, Vimercati A, Selvaggi L. Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding. Maturitas 1999; 33:139-144.
13. Karatepe F, Abali R, Bozkurt S, Arikan i,Sahin AE. Anormal uterin kanamalarin de¤erlendirilmesinde sonohisterografinin yeri. Jinekoloji ve Obstetrik Dergisi. 2004;18:44-49.
14. Kazandi M, Aksehirli S, Cirpan T, Akercan F. Transvaginal sonography combined with saline contrast sonohysterography to evaluate the uterine cavity in patients with abnormal uterine bleeding and postmenopausal endometrium more than 5 mm. Eur J Gynaecol Oncol 2003;24:185-190.
15. Kökden A, ilter E, Karalök H, Tüfekçi C, Temelli F. Anormal uterin kanamali kadinlarin degerlendirilmesinde, transvajinal ultrason, sonohisterografi ve endometrial biopsinin karsilastirimasi. TJOD Dergisi 2005;4:327-331.
16. Koonings P, Mayer D, Grimes D. A randomized clinical trial comparing Pipelle and Tis-U-Trap for endometrial biopsy. Obstet Gynecol 1990;75:293-295.
17. Krampl E, Bourne T, Sol-bakken HH, Istre O. Transvaginal ultrasonography, sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding. Acta Obstet Gynecol Scand 2001;80:616-622.
18. Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with postmenopausal uterine bleeding. Acta Obstet Gynecol Scand 1986;65:41-43.
19. Loffer FD. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of negative hysteroscopic view. Obstet Gynecol 1989;73:16-20.
20. Parsons AK, Lense JJ. Sonohysterography for endometrial abnormalities, preliminary results. J Clin Ultrasound 1993;21:87-95.
21. Pasrija S, Trivedi SS, Narula MK. Prospective study of saline infusion sonohysterography in evaluation of perimenopausal and postmenopausal women with abnormal uterine bleeding. J Obstet Gynaecol Res 2004;30:27-33.
22. Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, Brand R, Grady D. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. J Am Med Assoc 1998;280:1510-1517.
23. Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol 1975;45:537-541.
24. Stovall TG, Solomon SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol 1989;73:405-409.
25. Tabor A, Watt HC, Wald NJ. Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding. Obstet Gynecol 2002;99:663-670.
26. Turhan NÖ, Gümüfl ii. Anormal Uterin Kanamali Hastalar da transvajinal ultrasonografi, histerosonografi ve histeroskopinin tan›daki rolü. J Turkish German Gynecol Assoc 2005;6:123-129.
27. Valle RF. Hysteroscopic evaluation of patients with abnormal uterine bleeding. Surg Gynecol Obstet 1981;153:521526.
28. Valenzano MM, Lijoi D, Mistrangelo E, Fortunato T, Costantini S, Ragni N. The value of sonohysterography in detecting intracavitary benign abnormalities. Arch Gynecol Obstet 2005;272:265-268.
29. Van den Bosch T, Vandendael A, Wranz PA, Lombard CJ. Endopap-versus Pipelle- sampling in diagnosis of postmenopausal bleeding. Eur J Obstet Gynaecol Reprod Biol 1996;64:91-94.
30. Vuopala S. Diagnostic accuracy and clinical applicability of cytological and histological methods for investigating endometrial carcinoma. Acta Obstet Gynecol Scand Suppl 1977;70:1-72.
31. Yenen MC, Dede M, Göktolga Ü, Ercan M, Bafler i, Pabuccu R. Menometrorajik olgularda sonohisterografi ve ofis histeroskopinin yeri. Medikal Network Klinik Bilimler ve Doktor 2003;9:491-495.
32. Yumru AE, Bozkurt M, Çaylan Ö. Postmenopozal kanamal› vakalarda transvajinal sonografi, tan›sal histeroskopi ve histeroskopi sonrasi biopsinin de¤erlendirilmesi. Uluda¤ Üniversitesi Tip Fakültesi Dergisi 2004;30:97-101.