Comparison Of Endometrial Thickness Measured By Transvaginal Ultrasonography And Histopathologic Outcome In Premenopausal Patients With Abnormal Uterine Bleeding

Öz

Aim: This study aimed to evaluate endometrial thickness that measured with transvaginal ultrasonography TvUSG and histopathological results in women with abnormal uterine bleeding during perimenopausal period.Material and Methods: This retrospective study was conducted between March 2017 and May 2018 with the evaluation of 280 premenopausal patients between 35-50 years old who admitted to our clinic with abnormal uterine bleeding. Endometrial thickness was measured by TvUSG and mean endometrial thicknesses were evaluated according to histopathologic results of the patients. A normal endometrium biopsy is defined as a proliferative and secretory endometrium, and an abnormal endometrium as a polyp, simple or complex hyperplasia and endometrium cancer.Results: A total of 280 patients were included. 202 72.1% patients were reported histopathologically normal endometrium and 78 27.9% were abnormal endometrium. Mean age was 42 ± 4.2, median gravida 4 0- 10 , median parity 3 0-7 and mean body mass index 27.5±2.64 kg/ m2 were determined. Proliferative endometrium and secretory endometrium were the most frequent histopathologic findings with mean endometrial thickness of 7.13±3.81 mm and 8.42 ± 3.92 mm, respectively. Endometrial polyps were reported in 40 14.2% patients, simple endometrial hyperplasia in 33 11.7% patients and complex endometrial hyperplasia in 3 1.7% patients with abnormal histopathologic results and mean endometrial thicknesses were 13.41 ± 6.75 mm, 13.20 ± 7.75 mm and 14.54 ± 6.80 mm, respectively. 2 0.3% patients had endometrial cancer and the mean endometrial thickness was 21.41±2.75 mm.Conclusion: TvUSG is a non-invasive, safe and successful method that may be preferred as the first step in evaluating endometrial pathologies in premenopausal patients for abnormal uterine bleeding.

Anahtar Kelimeler

• Premenopause,abnormal uterine bleeding,transvaginal ultrasonography,endometrial thickness

Anormal Uterin Kanaması Olan Premenopozal Hastalarda Transvajinal Ultrasonografi İle Ölçülen Endometrial Kalınlık İle Histopatolojik Sonuçların Karşılaştırılması

Öz

Amaç: Bu çalışma perimenopozal dönemde anormal uterin kanaması olan kadınlarda transvajinal ultrasonografi TvUSG ile değerlendirilen endometrial kalınlık ile histopatolojik sonuçlarla karşılaştırılarak TvUSG’nin anormal endometrial biyopsi sonuçlarını tespit edebilme başarısını araştırmayı amaçlamaktadır.Gereç ve Yöntemler: Bu retrospektif çalışma Mart 2017- Mayıs 2018 yılları arasında anormal uterin kanama şikayeti ile polikliniğe başvurun 35-50 yaş arasında 280 premenopozal hastanın değerlendirilmesi ile yapılmıştır. TvUSG ile endometrial kalınlık ölçülerek hastaların histopatolojik sonuçlarına göre ortalama endometrial kalınlıkları değerlendirildi. Normal endometrium, biyopsi sonucunun proliferatif ve sekretuar endometrium; anormal endometrium ise biyopsi sonucu polip, basit veya kompleks hiperplazi ve endometrium kanseri olarak tanımlandı.Bulgular: Çalışmaya toplam 280 hasta dâhil edildi. Ortalama yaş 42±4.2 olup, ortanca gravida 4 0-10 , ortanca parite 3 0-7 ve ortalama vücut kitle indeksi 27.5±2.64 kg/m2 tespit edildi. Histopatolojik olarak 202 %72.1 hastada normal endometrium 78 %27.9 hastada anormal endometrium olarak raporlandı. Proliferatif endometrium ve sekretuar endometrium en sık histopatolojiler olup bu hastalarda ortalama endometrial kalınlık sırası ile 7.13±3.81 mm ve 8.42±3.92.mm saptanmıştır. Anormal histopatolojik sonuçlara bakıldığında 40 %14.2 hastada endometrial polip, 33 %11.7 hastada basit endometrial hiperplazi ve 3 %1.7 hastada kompleks endometrial hiperplazi olarak raporlanmış olup ortalama endometrial kalınlıklar sırası ile 13.41±6.75 mm, 13.20±7.75 mm ve 14.54±6.80 mm olarak değerlendirilmiştir. 2 %0.3 hastada endometrial kanser tespit edilmiş olup ortalama endometrial kalınlık 21.41±2.75 mm olarak ölçülmüştür.Sonuç: TvUSG, anormal uterin kanaması olan premenopozal hastalarda endometrial patolojileri değerlendirmede ilk basamak olarak tercih edilebilecek başarılı bir yöntemdir

Anahtar Kelimeler

• Premenopoz,anormal uterin kanama,transvajinal ultrasonografi,endometrial kalınlık

Kaynakça

1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA: a cancer journal for clinicians. 2011;61(4):212-36.
2. Sorosky JI. Endometrial cancer. Obstet Gynecol. 2008;111(2 Pt 1):436-47.
3. Clark TJ, Barton PM, Coomarasamy A, Gupta JK, Khan KS. Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies. BJOG : an international journal of obstetrics and gynaecology. 2006;113(5):502-10.
4. Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP. Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding. Maturitas. 2003;45(4):275-82.
5. Gupta JK, Chien PF, Voit D, Clark TJ, Khan KS. Ultrasonographic endo- metrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta obstetricia et gyneco- logica Scandinavica. 2002;81(9):799-816.
6. Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Se- gal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. Jama. 1998;280(17):1510-7.
7. van Doorn LC, Dijkhuizen FP, Kruitwagen RF, Heintz AP, Kooi GS, Mol BW. Accuracy of transvaginal ultrasonography in diabetic or obese women with postmenopausal bleeding. Obstet Gynecol. 2004;104(3):571-8.
8. Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol. 2003;188(2):401-8.

9. Ozdemir S, Celik C, Gezginc K, Kiresi D, Esen H. Evaluation of endo- metrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding. Archives of gynecology and obstetrics. 2010;282(4):395-9.
10. Sierecki AR, Gudipudi DK, Montemarano N, Del Priore G. Comparison of endometrial aspiration biopsy techniques: specimen adequacy. The Jour- nal of reproductive medicine. 2008;53(10):760-4.
11. Del Priore G, Williams R, Harbatkin CB, Wan LS, Mittal K, Yang GC. Endo- metrial brush biopsy for the diagnosis of endometrial cancer. The Journal of reproductive medicine. 2001;46(5):439-43.
12. Cooper JM, Erickson ML. Endometrial sampling techniques in the diag- nosis of abnormal uterine bleeding. Obstetrics and gynecology clinics of North America. 2000;27(2):235-44.
13. Goldstein SR, Nachtigall M, Snyder JR, Nachtigall L. Endometrial assess- ment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. American journal of obstetrics and gyne- cology. 1990;163(1 Pt 1):119-23.
14. Karlsson B, Granberg S, Wikland M, Ylostalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with post- menopausal bleeding--a Nordic multicenter study. American journal of obstetrics and gynecology. 1995;172(5):1488-94.
15. ACOG Committee Opinion No. 440: The Role of Transvaginal Ultraso- nography in the Evaluation of Postmenopausal Bleeding. Obstetrics and gynecology. 2009;114(2 Pt 1):409-11.
16. Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. Journal of ultrasound in medicine : official journal of the American Institu- te of Ultrasound in Medicine. 2001;20(10):1025-36.
17. Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hys- teroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12(8):1768-71.
18. Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonog- raphy-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177(1):102-8.
19. Getpook C, Wattanakumtornkul S. Endometrial thickness screening in premenopausal women with abnormal uterine bleeding. The journal of obstetrics and gynaecology research. 2006;32(6):588-92.
20. Dueholm M, Jensen ML, Laursen H, Kracht P. Can the endometrial thick- ness as measured by trans-vaginal sonography be used to exclude poly- ps or hyperplasia in pre-menopausal patients with abnormal uterine blee- ding? Acta obstetricia et gynecologica Scandinavica. 2001;80(7):645-51.