ENDOMETRİUM KARSİNOMLARINDA MYOMETRİAL İNVAZYONUN TRANSVAGİNAL ULTRASON İLE DEĞERLENDİRİLMESİ

Öz

Amaç: Endometriyum karsinomlar›nda miyometriyal invazyon ve servikal tutulumun önceden belirlenmesi, “Operasyon esnas›nda lenfadenektomi yap›lacak m›?” sorusunun yan›t›n›n ana belirleyicilerindendir. Bu çal›flmada preoperatif ultrasonografik inceleme ile miyometriyal invazyon ve servikal tutulumun de¤erlendirilmesi amaç- lanm›flt›r. Materyal ve Metot: Kad›n Hastal›klar› Kliniklerinde 2005 - 2007 y›llar› aras›nda çeflitli nedenlerle tedavi edilen 50 hasta çal›flmaya dahil edilmifltir. Preoperatif full küretaj ile histopatolojik endometriyal yap›s› tespit edilen bu hastalara, transvajinal ultrasonografi yap›larak endometriyal bazal tabakadan miyometriyum içine uzanan endometriyum dansitesindeki alanlar invazyon olarak de¤erlendirilip, hastalar yüzeyel invazyon, 1/2’den fazla ve 1/2’den az invazyon olarak s›n›fland›r›lm›flt›r. Servikal yay›l›m pozitif veya negatif olarak kay›t edilmifltir. Bu bulgular operasyon s›ras›nda elde edilen spesimenlerden k›yaslanarak ultrasonografinin bu amaçla preoperatif kullan›labilirli¤i de¤erlendirilmifltir. Bulgular: Servikal tutulumu olan 7 hastan›n 6’s›nda ultrasonografik olarak bu durum tespit edilebilmifltir (sensitivite %85,7; spesifite %100). Yüzeyel endometriyal yay›l›m› olan 9 hastan›n 6’s› do¤ru olarak de¤erlendirilmifl, bir hasta 1/2’den az, 2 hasta 1/2’den fazla miyometriyal invazyona sahip olarak de¤erlendirilmifltir (sensitivite %66,6; spesifite %100; do¤ruluk %47,4). Miyometriyumu 1/2’den az invaze olan 24 hastan›n 18’ine do¤ru tan› konulmufl, 6 hastan›n miyometriyal tutulumu 1/2’den fazla olarak de¤erlendirilirken, hiçbir hasta için yü- zeyel tutulum düflünülmemifltir (sensitivite %75; spesifite %28,5; do¤- ruluk %77,4). 1/2’den fazla miyometriyal invazyona sahip 17 hastan›n 13’ü do¤ru olarak teflhis edilmifltir (sensitivite %76,5; spesifite %11,1; do¤ruluk %65,4).

Anahtar Kelimeler

• Endometrium kanseri, Transvaginal ultrason, Miyometrial invazyon.

Öz

Aim: To assess the depth of myometrial invasion and cervical involvement in endometrial cancer using preoperative 6.5-MHz, highfrequency transvaginal ultrasonography is a crucial point to the question “Is it necessary to perform “lymphadenectomy” during endometrial carcinoma cases”. We aimed to f›nd the role of transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion and cervical involvement in patients with endometrial cancer. Material and Method: The study included 50 patients with histologically proven cancers of the endometrium between years 2005-2007 who attended to gynecology clinic. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of the uterine wall < 1/2, and outer half of the uterine wall >1/2. Cervical spread is recorded as positive or negative. The findings of the ultrasound examination are correlated with the pathological specimen and the preoperative applicability of ultrasound is evaluated. Results: Histologically proven cervical invasion that correlated with sonography was shown in 6 patients out of 7 (sensitivity %85,7; specificity %100). Of 9 patients with proven superficial myometrial invasion, 6 cases were revealed correctly by sonography whereas the depth of invasion was wrong estimated in 3 cases (sensitivity %66,6; specificity %100; accuracy %47,4). Out of 24 patients with proven myometrial invasion < 1/2, 18cases were correctly revealed by sonography. In 6 patients ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was overestimated in 6 cases (sensitivity %75; specificity %28,5; accuracy %77,4). Out of 17 patients with proven myometrial invasion > 1/2, 13cases were correctly revealed by sonography The depth of invasion was underestimated in 4 cases (sensitivity %76,5; specificity %11,1; accuracy %65,4).

Anahtar Kelimeler

• Endometrium carcinoma, transvaginal ultrasound, myometrial invasion.