Levent SİRVAN, Ali İrfan GÜZEL, Sabri CAVKAYTAR, Özlem EVLİYAOĞLU, Ufuk CERAN, Esma SARIKAYA, Mahmut Kuntay KOKANALI, Melike DOĞANAY

Anormal Uterin Kanaması Olan Premenopozal Kadınlarda Histeroskopik Bulgular Ve Histopatolojik Tanıların Karşılaştırılması

Amaç: Anormal uterin kanaması olan histeroskopi ve biyopsi yapılan premenopozal kadınlarda histeroskopi bulguları ile histopatolojik tanıların karşılaştırılması bu çalışmanın amacını oluşturur. Gereç ve Yöntemler: Ocak 2012 ve Şubat 2014 tarihleri arasında Ankara Dr Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi’ne anormal uterin kanama şikâyeti ile başvuran 1918 premenopozal hasta çalışma grubunu oluşturdu. Histeroskopi hasta kayıtlarından ,demografik ve reprodüktif özellikler kaydedildi. Bütün hastalara histeroskopi ve endometriyal biyopsi yapıldı.Histeroskopiler 4 mm.’ lik Karl-Storz teleskobu ve salin infüzyonu kullanılarak yapıldı.Histeroskopik bulgular ve histopatolojik tanılar normal,endometriyal polip,submüköz myom,endometriyal hiperplazi,endometriyal kanser ve diğerleri kayıp rahim içi araç,adezyon olarak sınıflandırıldı. Bulgular: 1918 histeroskopik bulgu içinde normal endometriyum %51.9 ile en sık bulgu olurken, sonra endometriyal polip %43.6 , submükoz myom %2.3 ,endometriyal hiperplazi %1.5 ve kayıp rahimiçi araç veya adezyon %0.7 tespit edilmiştir. Transvajinal ultrason ile ortalama endometriyum kalınlığı 11 mm olup ,7-20 mm arasında ölçülmüştür. En sık histopatolojik tanı hastaların %55.5 ‘inde görülen normal endometriyum iken, endometriyal polip %40.6 ile en sık ikinci tanıdır. Submüköz myom %2.3 ,endometriyal hiperplazi %1.5 ve kayıp rahim içi araç veya adezyon %0.7 diğer histopatolojik tanılardır. Histeroskopik bulgu ve histopatolojik tanılar içinde endometriyal kansere rastlanmamıştır. Sonuç: Histeroskopi premenopozal kadınlarda anormal uterin kanamanın değerlendirilmesinde önemlidir. Histeroskopik bulgular ve tanılar tecrübeli ellerde birbiriyle uyumludur.

Anahtar Kelimeler:

Anormal Uterin Kanama, Premenopoz, Histeroskopi

Comparison Of Hysteroscopic Findings And Histopathologic Diagnoses In Premenopausal Patients With Abnormal Uterine Bleeding

Aim: To compare the hysteroscopic findings and histopathologic results of premenopausal women with abnormal uterine bleeding who underwent hysteroscopy and biopsy. Material and Methods: 1918 premenopausal patients who attended to the Gynecology Department of Ankara Dr Zekai Tahir Burak Women’ Health, Education and Research Hospital between January 2012 and February 2014 with abnormal uterine bleeding AUB constituted the study group. In the hysteroscopy logs, demographic and reproductive features of patients were identified. All the patients underwent hysteroscopy and endometrial biopsy. Hysteroscopies were performed by using a 4 mm Karl-Storz telescope with saline as distension medium. Hysteroscopic findings and histopathological results were classified as normal, endometrial polyp, submucous myoma, endometrial hyperplasia, endometrial cancer and others lost intrauterine device, adhesion . Results: Among 1918 hysteroscopic findings, normal endometrium was the most frequent finding 51.9% and then endometrial polyp 43.6% ,submucous myoma 2.3% ,endometrial hyperplasia 1.5% and lost intrauterine device or adhesion 0.7% was reported. The median endometrial thickness measured by transvaginal ultrasonography was 11 mm with a range of 7-20 mm. The most frequent histopathologic diagnosis was normal endometrium in 55.5% of patients and endometrial polyp was the second most common diagnosis with an incidence of 40.6%. Submucous myoma 2.3% ,endometrial hyperplasia 1.5% and lost intrauterine device or adhesion 0.7% were the other histopathologic diagnoses. No endometrial cancer was reported as hysteroscopic finding and histopathologic diagnosis.Conclusion: Hysteroscopy is important in the evaluation of AUB in premenopausal women. Hysteroscopic findings and histopathologic diagnoses might correlate well in the experienced hands.

Keywords:

Abnormal Uterine Bleeding, Premenopause, Hysteroscopy,

PDF

___

Taylor PJ. Hysteroscopy: where have we been, where are we going? J Reprod Med. 1993;38:757-62.
Molloy D,Crosdale S.National trends in gynaecological endoscopic surgery. Aust N Z J Obstet Gynaecol. 1996;36:27-31.
Bettochi S, Nappi L, Ceci O, et al. Office hysteroscopy. Obstetrics and gynecology clinics of North America: advances in laparoscopy and hysteroscopy techniques, Philadelphia: W.B. Saunders Company; 2004. p. 641–54.
Sowter MC, Singla AA, Lethaby A. Pre-operative endometrial thinning agents before hysteroscopic surgery for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;2:CD001124.
Serden S. Diagnostic hysteroscopy to evaluate the cause of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000;27:277–86.
Tsai MC, Goldstein SR. Office diagnosis and management of abnormal uterine bleeding.Clin Obstet Gynecol. 2012 ;55:635-50.
Emanuel MH. New developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol. 2013 ;27:421-9
Munro MG, Critchley HO, Broder MS, et al.FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113:3–13.
Lasmar RB, Dias R, Barrozo PR, Oliveira MA, Coutinho Eda S, da Rosa DB.Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding. Fertil Steril. 2008;89:1803-7
Mettler L,Wendland EM, Patel P, Caballero R, Schollmeyer T. Hysteroscopy: an analysis of 2-year experience. JSLS 2002;6:195– 7.
Baggish MS, Barbot J. Contact hysteroscopy. Clin Obstet Gynecol. 1983;26:219–41.
Hamou JE. Microhysteroscopy: a new procedure and its original applications in gynecology. J Reprod Med. 1981; 26:375–82.
Pasqualotto EB, Margossian H, Price LL, et al. Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction. J Am Assoc Gynecol Laparosc. 2000;7:201–9.
de Wit AC, Vleugels MP, de Kruif JH. Diagnostic hysteroscopy: a valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma?. Six years of experience with non-clinical diagnostic hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2003 10;110:79-82.
Guin G, Sandhu SK, Lele A, Khare S.Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynaecol India. 2011 ;61:546- 9.
Schwarzler P, Concin H, Bosch H, et al. An evaluation of sonohysterography and diagnostic hysteroscopy for assessment of intrauterine pathology. Ultrasound Obstet Gynecol. 1998;11: 337–42.