Endometrial Örnekleme Yapılan Hastaların Sonografik Bulgularının ve Histopatolojik Sonuçlarının Değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, endometrial örnekleme yapılan olgularda histopatolojik sonuçlar
ve sonografik veriler arasındaki ilişkinin araştırılmasıdır.
Gereç ve Yöntem: Düzce Üniversitesi Tıp Fakültesi Hastanesi’nde Ocak 2015 - Ocak 2017
yılları arasında endometrial örnekleme yapılan hastaların sonuçları retrospektif olarak hastane
otomasyon sisteminden ve hasta dosyalarından incelenerek değerlendirildi. Hastalar
menopozal durumlarına göre premenopoz ve postmenopoz olarak sınıflandırılarak, hasta
gruplarındaki sonuçlar istatistiksel olarak karşılaştırıldı.
Bulgular: Hastaların 231’i premenopozal, 202’si postmenopozal dönemde idi. Premenopozal
hastaların ortalama endometrial kalınlıkları 10,42 ± 6,75 (mm, mean±SD) iken,
postmenopozal hastaların endometrial kalınlık ortalamaları 10,01 ± 7,26 (mm, mean±SD)
bulundu. Premalign lezyonların görülme oranı, her iki grupta benzer bulundu (p=0,87,
p=0,54). Postmenopozal 10 hastada malignite tanısı konuldu, bu hastaların tümünün ilk
başvuru şikayeti postmenopozal kanamaydı. Yapılan ROC analiz ile malignite için
endometrial kalınlık sınır değeri; 8,5 mm olarak bulundu. Premenopozal dönemde,
endometrial polip % 22,1 (n=51) oranında izlenirken, postmenopozal dönemde %16,3 (n=33)
oranında izlendi (p=0,014). Tamoksifen kullanan 8 hastanın patoloji sonucu %75 (n=6)
benign, %12,5 (n=1) premalign, %12,5 (n=1) malign olarak raporlandı.
Sonuç: Postmenopozal kanamalı hastalarda endometrial örnekleme malignite ekartasyonu
açısından hayatidir

Keywords

• Endometrial Kalınlık,Endometrium Kanseri,Endometrial Örnekleme,Postmenopoz

Evaluation of Sonographic Findings and Histopathologic Results of Endometrial Sampling Patients

Abstract

Objective: The aim of this study was to investigate the relationship between histopathologic
results and sonographic data in cases of endometrial sampling.
Methods: The results of patients who underwent endometrial sampling between January 2015
and January 2017 at the Düzce University Medical Faculty Hospital were examined
retrospectively from the hospital computer system and patient files. Patients were classified as
premenopausal and postmenopausal groups according to the results of the patient groups were
compared statistically.
Results: Based on clasified, 231 of patients were premenopausal and 202 were
postmenopausal. The mean endometrial thickness of premenopausal patients was 10.42 ± 6.75
(mm, mean ± SD), whereas the mean endometrial thickness of postmenopausal patients was
10.01 ± 7.26 (mm, mean ± SD). Premalign lesions were observed in similar proportions in
both groups (p=0.87, p=0.54). Ten patients detected with malignancy, all of them were
postmenopause and had bledding. Endometrial thickness cut-off value for malignancy was
found 8.5 mm by ROC analysis. In premenopausal group, endometrial polyp was observed in
22.1% (n = 51) and 16.3% (n = 33) in postmenopausal period (p = 0.014). The histopathology
results of 8 patients using tamoxifen were 75% (n = 6) benign, 12.5% (n = 1) premalign and
12.5% (n = 1) malignant.
Conclusion: Endometrial sampling in postmenopausal symptomatic patients is crutial in
terms of malignancy exclusion

Keywords

• Endometrium Cancer,Endometrial Sampling,Endometrial Thickness,Postmenopause

References

1. 1. ACOG Committee on Practice Bulletins Gynecology. Practice bulletin no. 136: Management Of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstet Gynecol. 2013 Jul;122(1):176- 85.
2. 2. Murray M.J., Meyer W.R., Zaino R.J., Lessey B.A., Novotny D.B., Ireland K., Zeng D., and Fritz M.A. A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women. Fertility and Sterility 2004; 81: pp. 1333-1343
3. 3. Albers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Phys. 2004;69:1915-26.
4. 4. Ronnett B, Kurman R. Precursor lesions of endometrial carcinoma. Blaustein's Pathology of Female Genital Tract. 2002;482.
5. 5. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. 2014 Yılı Türkiye Kanser İstatistikleri. http://kanser.gov.tr/Dosya/ca_istatistik/2014
6. 6. Smith RA, Cokkinides V& Eyre HJ. American cancer society guidelines for the early detection of cancer, 2005. CA: a Cancer Journal for Clinicians 2005; 55(1): 31–44
7. 7. Amant F, Moerman P, Neven P, ve ark. Endometrial cancer. Lancet 2005;366:491-505.
8. 8. Langer RD, Pierce JJ, O’Hanlan KA et al. Transvaginal ultrasonography compared with endometrial biopsy for the detection of endometrial disease. The New England Journal of Medicine 1997; 337(25): 1792–1798.

9. 9. Van Hanegem N. Et.al. The Accuracy of Endometrial Sampling İn Women With Postmenopausal Bleeding: A Systematic Review And Meta-Analysis, European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016-02-01, Volume 197, 147-155.
10. 10. Visser NCM, Reijnen C, Massuger LFAG, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of Endometrial Sampling in Endometrial Carcinoma: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017 Sep 5.
11. 11. Bülent Çakmak, Ahmet Karataş, Gupse Turan. Endometrial Örnekleme Sonuçlarımız: 400 Olgunun Analizi. Selçuk Tıp Derg 2012;28(3):163-166
12. 12. Fleischer AC, Wheeler JE, Lindsay I et al. An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms. American Journal of Obstetrics and Gynecology 2001; 184(2): 70–75
13. 13. Gambacciani M, Monteleone P, Ciaponi M et al. Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. Maturitas 2004; 48(4): 421–424.
14. 14. Gerber B, Krause A, Muller H et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: A prospective long-term study using transvaginal ultrasound. Journal of Clinical Oncology 2000; 18(20): 3464–3470
15. 15. Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: A Nordic multicenter study. Am J Obstet Gynecol 1995;172:1488–94.
16. 16. Dijkhuizen FP, Mol BW, Brolmann HA & Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89(8): 1765–1772.
17. 17. Alper Başbuğ, Derya Başbuğ, Müşerref Erkan, Mete Çağlar, Ali Yavuzcan. Postmenopozal vajinal kanamalı olgularda transvajinal ultrasonografi ve biyopsi sonuçlarının karşılaştırılması. Türk Jinekolojik Onkoloji Dergisi 2013-3, Sayfa 74-78
18. 18. Keskin S, Keskin DD, Gungul EE. Results of our endometrial samplings with pipelle: Analysis of 1950 cases. Yeni Tıp Dergisi. 2014;31:53–7.
19. 19. 19. Fisher B, Costantino JP, Wickerham DL et al. Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project P-1 study. Journal of the National Cancer Institute 1998; 90(18): 1371–1388
20. 20. Efetürk, Tünay, Mehmet Fırat Mutlu, and Haldun Güner. "Meme Kanseri Olan Hastalarda Yapılan Endometrial Örnekleme Sonrası Elde Edilen Histopatolojik Sonuçlar: 5 Yıllık Deneyim." Gazi Medical Journal 24.1 (2013).
21. 21. Anastasiadis PG1, Koutlaki NG, Skaphida PG et al. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol. 2000;21(2):180
22. 22. Dreisler E1, Stampe Sorensen S, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol. 2009 Jan;33(1):102-8.