Asemptomatik Postmenopozal Endometrial Kalınlık Artışının Değ erlendirilmesinde Histeroskopinin Etkinliği

Asemptomatik postmenopozal endometrial kalınlık artışı olan olgularda histeroskopinin etkinliğinin ve histopatolojik bulgular ile ilişkisinin belirlenmesi. Retrospektif olarak planlanan çalışmamız, transvajinal ultrasonografide(TVUS) endometrium kalınlığı >5 mm olan asemptomatik postmenopozal kadınların analizi ile gerçekleştirilmiştir. TVUS’de endometrium kalınlığı >5 mm olan hastalara ofis koşullarında histeroskopi ve endometrial biyopsi örneklemesi uygulanmıştır. Yapılan ofis histeroskopi ve histopatolojik inceleme sonuçları karşılaştırmalı olarak analiz edilmiş, histeroskopinin predikte edici etkisi sensitivite, spesifisite, pozitif ve negatif prediktif değerlerine göre değerlendirilmiştir. Retrospektif analizde 168 hasta değerlendirilmiş, eksik verileri olan ve histopatolojik inceleme sonuçlarına ulaşılamayan 62 hasta çalışma dışı bırakılmıştır. Toplamda 106 hasta çalışma grubu olarak belirlenerek analizler gerçekleştirilmiştir. Hastaların ortalama yaşları(yıl), menopoz yaşları(yıl) ve endometrium kalınlıkları(mm) sırasıyla; 55.3±8.5, 47.8±5.4 ve 9.5±4.2 olarak tespit edilmiştir. Histopatolojik bulguların dağılımına bakıldığında normal veya atrofik bulgular, endometrial polip, leiomyoma uteri, basit endometrial hiperplazi, atipili/kompleks endometrial hiperplazi, endometrial karsinom ve yetersiz materyal oranları sırasıyla 9(%8.5), 61(%57.5), 6(%5.7), 16(%15.1), 5(%4.7), 1(%0.9) ve 8(%7.5) olarak saptanmıştır. Histeroskopi buluguları değerlendirildiğinde ise normal görünüm, hiperplazik görünüm, endometrial polip, submuköz myom ve tümör/karsinom görünümü olarak sırasıyla 30(%28.3), 16(%15.1), 53(%50), 6(%5.7) ve 1(%0.9) olguda tespit edilmiştir. Histeroskopi incelemesinin nihai tanı yöntemi olan histopatolojik sonuçlarını öngörme durumunu değerlendirmek için yapılan ve her bulgu için ayrı ayrı gerçekleştirilen analizde histeroskopinin en duyarlı olduğu normal veya atrofi bulguları olan ve ikinci sırada en duyarlı olduğu ise endometrial polip saptanan olgular olarak belirlenmiştir. Duyarlılığının en düşük olduğu lezyon ise endometrial hiperplazi olguları olmuştur. Histeroskopi, postmenopozal endometrial kalınlık artışı olan hastalarda benign veya şüpheli malign olguların değerlendirilmesinde doğru tanı olanağı sağlamaktadır. Eş zamanlı biyopsi olanağı sağlaması lezyonun yerinin net belirlenmesi faydaları arasında yer almaktadır. Atrofik endometrium gibi olgularda da gereksiz biyopsi durumunu ortadan kaldırmaktadır. Özellikle polip gibi intrakaviter patolojilerde saptama oranı belirgin artmaktadır. Endometrial hiperplazi gibi histeroskopi ile saptanma oranı düşük olgularda küretaj ile örnekleme yapılması gerekliliği de unutulmamalıdır.

The Effectivenss of Hysteroscopy in Evaluatinğ Asymptomatic Postmenopausal Patients with Thickened Endometrium

To assess the association between the hysteroscopy and histopathological findings in asymptomatic postmenopausal patients with thickened endometrium. This retrospective study was performed in asymptomatic postmenopausal patients with endometrial thickness that was revealed by transvaginal ultrasonography as > 5mm. Office hysteroscopy and endometrial biopsy were performed to all patients. The outcomes of hysteroscopy and histopathology were compared and sensitivity, specificity, positive and negative predictive values of hysteroscopy were determined. One hundred and sixty-eight patients were evaluated, patients who have not enough data and histopathological findings were excluded. After exclusion criterias, totally 106 patients were analyzed. Mean age(years), age of menopause(years) and endometrial thickness(mm) were 55.3±8.5, 47.8±5.4 and 9.5±4.2 respectively. We assessed the histopathological findings as normal or atrophic, endometrial polyp, simple endometrial hyperplasia, atypical/complex endometrial hyperplasia, endometrial carcinoma and insufficient material in 9(8.5%), 61(57.5%), 6(5.7%), 16(15.1%), 5(4.7%), 1(0.9%) and 8(7.5%) patients, respectively. Hysteroscopic findings were established as normal appearance, hyperplasia, endometrial polyp, submucous myoma and tumor/carcinoma in 30(28.3%), 16(15.1%), 53(50%), 6(5.7%) and 1(0.9%) patients, respectively. Hysteroscopy evaluation was compared with the histopathology which approved as a gold standard procedure to determine the definitive diagnosis and the analysis was performed for each finding separately. The hysteroscopy was more sensitive in normal or atrophic endometrium and endometrial polyps were determined by hysteroscopy with high sensitivity. The lowest sensitivity was obtained in endometrial hyperplasia. Hysteroscopy enables effective and accurate diagnosis to evaluate benign and suspected malign cases in postmenopausal patients with thickened endometrium. The advantages of hysteroscopy were opportunity for concurrent biopsy and detection the correct location of the lesions. Hysteroscopy also eliminates the unnecessary biopsies for atrophic endometrium. The sensitiviy of hysteroscopy increases especially in intracavitary pathologies such as endometrial polyps. It should not be forgotten the necessity of curettage in endometrial hyperplasias that can not be detected clearly with hysteroscopy.

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