Comparison of endometrial thickness and probe curettage results in patients with postmenopausal vaginal bleeding

Yıl 2002, Cilt: 33 Sayı: 1, 3 - 5, 01.02.2002

Bülent Özçelik İptisam İpek Müderris

Öz

Objective: To compare endometrial probe curettage results with sonographic endometrial thickness in women with postmenopausal uterine bleeding were not given hormone replacement therapy. Materials and Methods: One hundred twenty patients with abnormal uterine bleeding who have never use any hormonal therapy were evaluated with vaginal examination and their endometrial thickness were measured by transvaginal ultrasonography. After these procedures endocervical and endometrial samples were taken in every patient under general anesthesia and results were evaluated. Results: Mean endometrial thickness was 4.7±0.2 mm in 120 patients with postmenopausal abnormal uterine bleeding. The pathology report confirmed that 73 (% 60.8) patients with atrophie endometrium, 20 (% 16.7) with insufficient material, 10 (% 8.3) with proliferative endometrium, 5 (% 4.2) with endometrial polyp, 10 (% 8.3) with simple endometrial hyperplasia, 2 (% 1.7) with atypical hyperplasia. Conclusion: We conclude that every patient complaining about postmenopausal uterine bleeding must be evaluated with endometrial sampling even if their endometrial thickness less than 5 mm in transvaginal ultrasonographic exam.

Anahtar Kelimeler

Postmenopause, Hemorrhage, Ultrasonography, Endometrium, Curettage

Postmenopozal vajinal kanamalı hastalarda endometrium kalınlığı ile probe küretaj sonuçlarının karşılaştırılması

Öz

Amaç: Postmenopozal vajinal kanama ile başvuran ve hormon replasman tedavisi almayan hastalarda endometrial kalınlığın ölçülerek probe küretaj sonuçları ile karşılaştırılması. Materyal ve Metod: Herhangi bir menopoz tedavisi almayan ve postmenopozal vajinal kanama şikayeti ile başvuran 120 hastaya jinekolojik muayene ve vajinal ultrasonografi yapılarak endometrial kalınlık ölçüldü. Takiben her hastaya genel anestezi altında probe küretaj yapıldı ve sonuçlar değerlendirildi. Bulgular: Postmenopozal vajinal kanama şikayeti ile gelen 120 hastanın ortalama endometrium kalınlığı 4.7±0.2 mm idi. Probe küretaj sonuçlarında ise 73 (% 60.8) hastada atrofik endometrium, 20 (% 16.7) hastada yetersiz endometrium, 10 (% 8.3) hastada proliferatif endometrium, 5 (% 4.2) hastada endometrial polip, 10 (% 8.3) hastada basit endometrial hiperplazi, 2 (% 1.7) hastada atipi gösteren endometrial hiperplazi görüldü. Sonuç: Postmenopozal vajinal kanama ile başvuran her hastaya 5 mm'nin endometrial kalınlık tespit edilse bile mutlaka probe küretaj yapılmalıdır. Böylece premalign bir lezyon olarak kabul edilen hiperplazi olguları da gözden kaçmamış olacaktır.

Anahtar Kelimeler

Postmenopoz, Kanama, Ultrasonografi, Endometriyum, Küretaj

Kaynakça

• I) Chambers JT, Chambers SK: Endometrial sampling; When? Where? Why? With What? Clin Obstet Gynecol, 1992; 35; 29-39
• 2) Nesse R: Abnormal vaginal bleeding in perimenopozal bleeding, Am Fam Physcian, 1989; 40; 185
• 3) Aydınlı K, Kaleli S, Atasü T: Jinekolojik kanserlerin erken tanısı in Aydınlı K, Atasü T (eds). Jinekolojik Onkoloji, 2. baskı, Logos yayıncılık, İstanbul, 1999; 133
• 4) Gore H, Hertig AT: Carcinoma in situ of endometrium. Am J Obstet Gynecol ,1966; 94: 134
• 5) Lurain JR:Uterin cancer in Berek JS, Adashi EY, Hillard PA ( eds ). Novaks Gynecology, 12 th edition, Williams and Wilkins, Long Kong 1996; 1056
• 6) Kurman RJ, Kaminski PF, Norris HJ: The behavior of endometrial hyperplasia. Along term study of untreated hyperplasia in 170 patients
• Cancer, 1985; 56: 403
• 7) Ayhan A: Endometrium kanseri in Kişnişçi, Gökşin, Durukan, Üstay, Ayhan, Gürgan, Önderoğlu (eds). Temel kadın hastalıkları ve doğum bilgisi,Güneş kitabevi,.Ankara 1996; 963
• 8) Kuşçu NK, Laçin S, Ayhan S, Yıldırım Y, Kurtul Ö, Koyuncu F: Perirrienopozal ve postmenopozal kanamada probe küretaj sonuçlarının karşılaştırılması. Jinekoloji ve Obstetrik 2000; 14:231
• 9) Feldman S, Shapter A, Welch WR, Berkowitz RS:Two year follow up of 263 patients with post/permenopausal vaginal bleeding and negative initial biopsy. Gynecol Oncol, 1994; 55,56
• 10) Hall KL, Dewar MA, Perchalski J : Screening of gynecologic cancer. Vulvar, vaginal, endometrial, and ovarian neoplasms. Prim Care 1992; 19: 607
• 11) Goldstein SR, Nachtigall M, Snyder R, Nachtigal L: Endometrial assessment by vaginal ultrasonography before sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol 1990; 163: 119-23
• 12) Granberg S, Wikland M, Karlsson B, Norström A, Friberg LG: Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol 1991; 164: 47-52
• 13) Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB: Ultrasonography-based triage for postmenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol 1997; 177: 102-8
• 14) Holbert TR. Transvaginal ultrasonographic measurement of endometrial thickness in postmenopausal women receiving estrogen replacement therapy: Am J Obstet Gynecol 1997; 176: 1334-9