Ceyda USTA, Neşe YÜCEL, Gökhan GÖYNÜMER, Ergun BİLGİÇ

Anormal uterin kanaması olan hastaların tanısında transvaginal ultrasonografi ve ofis histeroskopinin yeri

Amaç: Bu çalışmanın amacı anormal uterin kanaması olan kadınlarda endometrial patolojilerin saptanmasında transvaginal ultrasonografi (TvUSG) ve ofis histeroskopinin tanıdaki etkinliğini belirlemektir. Gereç ve Yöntemler: Bu retrospektif çalışmada, anormal uterin kanama şikâyeti ile başvuran toplam 59 hastanın sonuçları değerlendirildi. Tüm hastalara pelvik muayene, transvajinal ultrasonografi, ofis histeroskopi ve endometrial biopsi sonuçları kaydedildi. Değerlendirme yapılırken transvajinal ultrasonografi ve ofis histeroskopi bulguları endometrial biopsi tanıları ile karşılaştırıldı. Her iki yöntemin; sensitivite, spesifite, PPD ve NPD’ler hesaplandı. Ayrıca TvUSG ve histeroskopinin tanıdaki etkinliğini belirlemek için ROC analizi yapıldı. Bulgular: Çalışmaya alınan hastaların ortalama yaşı 47.2±9.94 ve %32,2 (n=19) postmenopozal dönemdeydi. TvUSG’nin Endometriyal patolojilerin tanısında ki; sensitivitesi %53,5, spesifisitesi %43,7, PPD %71,8 ve NPD %25,9 olarak bulundu. Ofis Histeroskopinin ise endometrial patolojileri tespit etmedeki sensivitesi % 79, spesifitesi % 87.5, PPD %94.4 ve NPD %60.8 olarak bulundu. TvUSG’nin endometriyal poliplerde sensitivitesi %48,5 spesifisitesi %64,2, PPD %61,5, NPD %51,4. Submuköz myomlarda sensitivitesi %100,0, spesifisitesi %98,1, PPD %83,3, NPD %100,0 olarak bulundu. Ofis Histeroskopinin endometrial poliplerde sensitivitesi %78,8, spesifisitesi %93,9, PPD %92,8, NPD %81,5. Submuköz myomlarda sensitivitesi %100,0, spesifisitesi %94,4, PPD %62,5, NPD %100,0 olarak bulundu. Sonuç: Ofis histeroskopinin intrauterin kavitedeki polip ve submüköz myom gibi anormalliklerin saptanmasında tanısal doğruluğu TvUSG’den üstündür. Anormal uterin kanamalı kadınların değerlendirilmesinde histeroskopi eşliğinde yapılan endometrial biopsi en doğru sonucun elde edilmesini sağlar.

Anahtar Kelimeler:

transvaginal ultrasonografi, ofis histeroskopi, anormal uterin kanama, endometrial polip

The role of transvaginal ultrasonography and office hysteroscopy in the diagnosis of patients with abnormal uterine bleeding

Aim: The aim of this study is to evaluate the role of office hysteroscopy and transvaginal ultrasonography (TvUSG) in the assessment of endometrial cavity of patients with abnormal uterine bleeding. Materials and Methods: In this retrospective study, a total of 59 patients who had abnormal uterine bleeding were evaluated. All of the patients underwent pelvic examination, transvaginal ultrasonography, office hysteroscopy and endometrial biopsy. During the evaluation, transvaginal ultrasonography and office hysteroscopy findings were compared with endometrial biopsy results. Both transvaginal ultrasonography and office hysteroscopy methods; the sensitivity, specificity, PPD and NPDs were calculated. In addition, ROC analysis was performed for TvUSG and office hysteroscopy. Results: The mean age of the patients was 47.2 ± 9.94 and 32.2% (n = 19) were in the postmenopausal period. The sensitivity of TvUSG in the diagnosis of endometrial pathologies was 53.5%, specificity 43.7%, PPD 71.8%, NPD 25.9%. The sensitivity of office hysteroscopy in detecting endometrial pathologies was 79.0%, specificity 87.5%, PPD 94.4% and NPD 60.8%. The sensitivity of TvUSG in endometrial polyps was 48.5%, specificity was 64.2%, PPD 61.5%, NPD 51.4%. The sensitivity of TvUSG in leiomyomas was 100.0%, specificity was 98.1%, PPD was 83.3%, and NPD was 100.0%. The sensitivity of office hysteroscopy in leiomyomas was 78.8%, specificity 93.9%, PPD 92.8%, NPD 81.5%. The sensitivity of office hysteroscopy in endometrial polyps was 100.0%, specificity 94.4%, PPD 62.5% and NPD 100.0% Conclusion: The sensitivity and specificity of office hysteroscopy in detection of intrauterine abnormalities such as polyps and submucous leiomyoma, is higher than the TvUSG. In the evaluation of endometrial pathology, combine of office hysteroscopy with endometrial sampling has the best diagnostic accuracy.

Keywords:

transvaginal ultrasonography, office hysteroscopy, abnormal uterine bleeding, endometrial polyp,

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