Serkan KAHYAOĞLU, Salim ERKAYA, Hüseyin ŞENYURT, Ömer Hamid YUMUŞAK, Selçuk ERKILINÇ

Histerektomi Öncesi Yapılan Endometriyal Örneklemenin Tanısal Doğruluğunun Değerlendirilmesi

Amaç: Preoperatif dönemde yapılan endometriyal örnekleme işleminin tanısal doğruluğunun değerlendirilmesi bu çalışmanın amacını oluşturur. Gereç ve Yöntemler: S.B. Ankara Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde Ocak 2003- Nisan 2006 yılları arasında çeşitli endikasyonlarla histerektomi yapılan 198 olgu çalışmaya dahil edildi. Preoperatif endometriyal örnekleme bulgularında ve postoperatif endometriyum bulgularında; endometriyal hiperplazi, atipik endometriyal hiperplazi, endometriyum kanseri ve endometriyal polip gibi histopatolojik sonuçlar anormal endometriyal örnekleme-bulgu olarak alındı. Bunun yanı sıra atrofik endometriyum, proliferatif endometriyum, sekretuar endometriyum gibi sonuçlar ise normal endometriyal örnekleme-bulgu olarak kabul edildi. Preoperatif endometriyal örneklemenin postoperatif histerektomi materyallerinde tespit edilen lezyonları belirlemedeki sensitivite ve spesifiteleri değerlendirildi. Bulgular: 198 olguda ortalama yaş 48 olarak bulundu. Histerektomi olgularında en sık endikasyon %54.5 oranıyla myom varlığı idi. Endometriyal örneklemenin basit atipisiz endometriyal örneklemede tanı doğruluğu %82.6, atipik endometriyal hiperplazide %33.3, endometriyal karsinomada %92.9 olarak bulundu. Myoma uteri bulunan olgularda endometriyal örneklemelerin anormal endometriyal bulguyu belirlemedeki sensitivite ve spesifite değerleri sırasıyla %27.7 ve % 69.6 olarak bulundu. Benign ön tanılarla histerektomi yapılan olgularda endometriyal örneklemenin anormal endometriyal bulguları saptamadaki sensitivite ve spesifite değerleri sırasıyla % 36.6 ve %73.4 olarak bulundu. Malign ön tanı ile opere edilen hastalarda sensitivite ve spesifite değerleri sırasıyla % 100 ve % 99 olarak bulundu. Sonuç: Çalışmamızda preoperatif endometriyal örneklemenin anormal endometriyal bulguyu saptamada malign olgularda duyarlılık ve özgüllüğünün yüksek olduğu, benign ön tanılarla opere edilen olgularda ise düşük olduğu gözlenmiştir.

Evaluation of The Diagnostic Accuracy of Endometrial Sampling Before Hysterectomy

Aim: To evaluate diagnostic accuracy of preoperative dilatation and curettage procedure Material and Methods: A total of 198 patients who underwent hysterectomy with various indications at Ankara Education and Research Hospital between January 2003 and April 2006 were included in the study. Endometrial cancer, hyperplasia or polyps were considered as abnormal uterine findings. Secretory endometrium and proliferative endometrium were considered as normal endometrial findings. The sensitivity and specifity of preoperative endometrial sampling in determining postoperative endometrial lesions were calculated. Results: Mean age was 48 years. The most common indication for hysterectomy was myoma uteri with an incidence of 54.5%. The distribution of diagnostic accuracy of endometrial sampling according to endometrial pathologies were as follows; simple endometrial hyperplasia: 82.6%, atypical endometrial hyperplasia: 33.3%, endometrial cancer: 92.9%. The sensitivity and specifity of endometrial sampling in determining abnormal endometrial findings in patients with uterine leiomyoma were 27.7% and 69.6% respectively. The sensitivity and specifity of endometrial sampling in determining abnormal endometrial findings in patients that underwent hysterectomy for benign conditions were 36.6% and 73.4 % respectively. The sensitivity and specifity of endometrial sampling in detection of abnormal endometrial findings in patients that underwent hysterectomy for endometrial carcinoma was 100 % and 99 % respectively. Conclusion: Our study suggested that preoperative endometrial sampling had high sensitivity and specifity in malign cases and had low sensitivity and specifity in benign cases.

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