Yeliz DADALI, Aynur TURAN, Bayram AYDIN, Olcay A. ÇİNER, Alper DİLLİ, Pınar KOŞAR

Postmenopozal kanaması olan hastalarda transvajinal ultrasonografi ile endometriumun değerlendirilmesi ve histopatoloji sonuçları ile karşılaştırılması

Amaç: Endometrium karsinomu, gelişmiş ülkelerde en sık rastlanan kadın genital kanseridir. Endometrium karsinomu için bir tarama programı geliştirilmemiştir. Bu nedenle asemptomatik hastalarda tanı ve tedavi gecikmektedir. Bu çalışma transvajinal ultrasonografinin endometrium patolojilerinin araştırmak amacıyla yapılmıştır.Gereç Yöntem: Bu araştırmada postmenopozal kanama (PMK) şikayeti ile başvuran toplam 52 hastaya transvajinal ultrasonografi (TVUS) yapılmış, probe küretaj sonuçları ile karşılaştırılmıştır. Bulgular: Bizim çalışmamızdaki 52 hastanın 5'inde endometrium karsinomu tespit edilmiştir. Endometrium karsinomu grubunda ortalama endometrium kalınlığı TVUS'de 20.6 mm iken patolojik grupta (endometrial hiperplazi ve endometrial karsinom) endometrium kalınlığı 15.3 mm, benign grupta ise (atrofik endometrium, yetersiz materyal, proliferatif/sekretuar endometrium) 4.4 mm olarak bulunmuştur. Transvajinal ultrasonografi ile endometrial patolojilerin ayırt edilmesinde endometrium kalınlığı için eşik değeri 5 mm olarak alınmıştır. Bu değere göre PMK'lı hastalarda endometrial patolojilerin saptanmasında sensitivite % 100, spesifitesi % 79.4, pozitif prediktif değeri (PPV) % 71 ve negatif prediktif değeri (NPV) ise %100'dür. Buna bağlı olarak TVUS ile endometrium kalınlığı 5 mm veya altında bulunan PMK kadınlarda kanamanın nedeni olarak endometrial bir patoloji bulunması riski çok düşüktür.Sonuç: TVUS, kanaması olan kadınlarda bir tarama metodu olarak kullanılabilir ve ileri invaziv girişimlere gerek duyulan hastaları seçebilir. Ancak sonografik olarak endometrial benign ve malign lezyonları ayırt etmek mümkün olmadığından postmenopozal kanamalı hastalarda dilatasyon ve küretaj (D&C) standart diagnostik prosedür olarak yerini korumalıdır.

The evaluation of the endometrium with transvaginal ultrasound in the postmenoposal patients with vaginal bleeding and comparison of the ultrasonographic findings with histopathologic analysis

Objective: Endometrial carcinoma is the most prevalent female genital cancer in the developed countries. There has not been any scanning program developed for the endometrial carcinoma. This causes delay in diagnosis and treatment in asymptomatic patients. This study was conducted with the aim of examining the reliabilty of transvaginal ultrasonograpy in the evaluation of endometrial pathologies. Material-Method: In the study, transvaginal ultrasonograpy was conducted on 52 patients who were admitted to our hospital with postmenopausal bleeding complaints, and images obtained were compared with the probe curettage results. Results Endometrial carcinoma was detected in 5 out of 52 patients in our study. Median endometrial thickness in the endometrial carcinoma group was 20.6 mm in the transvaginal ultrasonography where endometrial thickness was accepted as 15.3 mm in pathologic group (endometrial carcinoma, endometrial polyp) and it was found to be 4.4 mm in the benign group (atrophic endometrial, insufficient material, prolipherative/secretory endometrial). The cutt-off value was taken as 5 mm for endometrial thickness in the differentiation of endometrial pathologies by transvaginal ultrasonography. Sensitivity of transvaginal ultrasonography in the detection of pathologic endometrial is 100%, specifity 79.4%, positive predictive value 71% and negative predictive value is 100%. Therefore, the risk of finding endometrial pathology as the reason for the bleeding in patients whose endometrial thickness is found to be 5 mm or less by transvaginal ultrasonography would be very low. Discussion Transvaginal ultrasonography could be used as a screening modality in women with bleeding, and could select the patients who need further invasive procedure. However, as it is not possible to distinguish endometrial benign and malign lesions by ultrasonography, the standard D&C should keep its place as the diagnostic procedure in patients with postmenopausal bleeding.

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