Evaluation of The Diagnostic Accuracy of Endometrial Sampling Before Hysterectomy

Öz

Aim: To evaluate diagnostic accuracy of preoperative dilatation and curettage procedure. Material and Methods: A total of 198 patients who underwent hysterectomy with various indications at Ankara Education and Research Hospital between January 2003 and April 2006 were included in the study. Endometrial cancer, hyperplasia or polyps were considered as abnormal uterine findings. Secretory endometrium and proliferative endometrium were considered as normal endometrial findings. The sensitivity and specifity of preoperative endometrial sampling in determining postoperative endometrial lesions were calculated.Results: Mean age was 48 years. The most common indication for hysterectomy was myoma uteri with an incidence of 54.5%. The distribution of diagnostic accuracy of endometrial sampling according to endometrial pathologies were as follows; simple endometrial hyperplasia: 82.6%, atypical endometrial hyperplasia: 33.3%, endometrial cancer: 92.9%. The sensitivity and specifity of endometrial sampling in determining abnormal endometrial findings in patients with uterine leiomyoma were 27.7% and 69.6% respectively. The sensitivity and specifity of endometrial sampling in determining abnormal endometrial findings in patients that underwent hysterectomy for benign conditions were 36.6% and 73.4 % respectively. The sensitivity and specifity of endometrial sampling in detection of abnormal endometrial findings in patients that underwent hysterectomy for endometrial carcinoma was 100 % and 99 % respectively. Conclusion: Our study suggested that preoperative endometrial sampling had high sensitivity and specifity in malign cases and had low sensitivity and specifity in benign cases.

Anahtar Kelimeler

• Endometrial sampling,Hysterectomy

Histerektomi Öncesi Yapılan Endometrial Örneklemenin Tanısal Doğruluğunun Değerlendirilmesi

Öz

Amaç: Preoperatif dönemde yapılan endometriyal örnekleme işleminin tanısal doğruluğunun değerlendirilmesi bu çalışmanın amacını oluşturur. Gereç ve Yöntemler: S.B. Ankara Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde Ocak 2003- Nisan 2006 yılları arasında çeşitli endikasyonlarla histerektomi yapılan 198 olgu çalışmaya dahil edildi. Preoperatif endometriyal örnekleme bulgularında ve postoperatif endometriyum bulgularında; endometriyal hiperplazi, atipik endometriyal hiperplazi, endometriyum kanseri ve endometriyal polip gibi histopatolojik sonuçlar anormal endometriyal örnekleme-bulgu olarak alındı. Bunun yanı sıra atrofik endometriyum, proliferatif endometriyum, sekretuar endometriyum gibi sonuçlar ise normal endometriyal örnekleme-bulgu olarak kabul edildi. Preoperatif endometriyal örneklemenin postoperatif histerektomi materyallerinde tespit edilen lezyonları belirlemedeki sensitivite ve spesifiteleri değerlendirildi.Bulgular: 198 olguda ortalama yaş 48 olarak bulundu. Histerektomi olgularında en sık endikasyon %54.5 oranıyla myom varlığı idi. Endometriyal örneklemenin basit atipisiz endometriyal örneklemede tanı doğruluğu %82.6, atipik endometriyal hiperplazide %33.3, endometriyal karsinomada %92.9 olarak bulundu. Myoma uteri bulunan olgularda endometriyal örneklemelerin anormal endometriyal bulguyu belirlemedeki sensitivite ve spesifite değerleri sırasıyla %27.7 ve % 69.6 olarak bulundu. Benign ön tanılarla histerektomi yapılan olgularda endometriyal örneklemenin anormal endometriyal bulguları saptamadaki sensitivite ve spesifite değerleri sırasıyla % 36.6 ve %73.4 olarak bulundu. Malign ön tanı ile opere edilen hastalarda sensitivite ve spesifite değerleri sırasıyla % 100 ve % 99 olarak bulundu. Sonuç: Çalışmamızda preoperatif endometriyal örneklemenin anormal endometriyal bulguyu saptamada malign olgularda duyarlılık ve özgüllüğünün yüksek olduğu, benign ön tanılarla opere edilen olgularda ise düşük olduğu gözlenmiştir.

Anahtar Kelimeler

• Endometrial örnekleme,histerektomi

Kaynakça

1. Goldstein SR. Modern evaluation of the endometrium. Obstet Gynecol 2010;116:168-76.
2. Jonatan S, Berek J. Novak’s Gynecology. 14th. New York: Lipp. Williams and Wilkins; 2012.
3. Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases. J Mid-life Health. 2013;4:216-20.
4. Word B, Gravlee LC, Wideman GL. The fallacy of simple uterine curettage. Obstet Gynecol 1958;12:642-8.
5. Emanuel MH, Wamsteker K, Lammes FB. Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding? Acta Obstet Gynecol Scand. 1997;76:65-8.
6. Stovall TG, Solomon SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol. 1989;73:405-9.
7. Te Linde RW, Rock JA, Thompson JD. Te Linde’s operative gynecology: Lippincott-Raven Philadelphia; 1997.
8. Lü W, Xie X, Ye D. [Evaluation of diagnosis of endometrial hyperplasia by curettage]. Zhonghua yi xue za zhi. 2001;81:816-8.

9. Bettocchi S, Ceci O, Vicino M, Marello F, Impedovo L, Selvaggi L. Diagnostic inadequacy of dilatation and curettage. Fertil Steril. 2001;75:803-5.
10. Lerner HM. Lack of efficacy of prehysterectomy curettage as a diagnostic procedure. Am J Obstet Gynecol 1984;148:1055-6.
11. Grimes D. Diagnostic dilation and curettage: a reappraisal. Am J Obst Gynecol. 1982;142:1-6.
12. Kendall BS, Ronnett BM, Isacson C, Cho KR, Hedrick L, Diener- West M, et al. Reproducibility of the diagnosis of endometrial hyperplasia, atypical hyperplasia, and well-differentiated carcinoma. Am J Surg. Pathol 1998;22:1012-9.
13. Agostini A, Cravello L, Bretelle F, Demaisonneuve AS, Roger V, Blanc B. Risk of discovering endometriyal carcinoma or atypical hyperplasia during hysteroscopic surgery in postmenopausal women. J Am. Ass. Gynecol Lap. 2001;8:533-5.
14. Zhou R, Shen DH, Wang CH, Geng J, Wang JL, Wei LH. [Application of endometrial sampling device during the follow-up visit for the conservative treatment of endometrial cancer]. Zhonghua fu chan ke za zhi. 2013;48:896-8.
15. 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 Gynecol 2012;32:790-4.
16. Saadia A, Mubarik A, Zubair A, Jamal S, Zafar A. Diagnostic accuracy of endometrial curettage in endometriyal pathology. J Ayub Med Coll Abb. 2011;23:129-31.
17. Fakhar S, Saeed G, Khan AH, Alam AY. Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding. Ann. of Saudi Med. 2008;28:188-91.