Banu ÇAYLARBAŞI, Semih TUĞRUL, Şebnem İNAL, Özay ORAL, SÜLEYMAN MURAT BAKACAK

Postmenopozal kanamada transvaginal ultrasonografi ile endometrial kalınlığın değerlendirilmesi

Amaç: Bu çalışmada postmenopozal kanamalı hastalarda endometrial kanser tanısında, diagnostik bir araç olarak vajinal ultrasonografi'nin sensitivite ve spesitivitesini değerlendirmeyi amaçladık. Materyal ve Metod: Postmenopozal kanamalı 84 hastanın endometrial kalınlıkları vajinal ultrasonografi ile ölçüldü. Histopatolojik tam, dilatasyon ve küretaj sonuçlarına dayandırıldı. Her histopotolojik tanı için ortalama endometrial kalınlık ve SD hesaplandı. Malignité tanısında belirli endometrial kalınlıklar için, cut off point bulma yaklaşımıyla, sensitivite, spesitivite, pozitif ve negatif prediktif değerler ve göreli risk değerleri ölçüldü. Bulgular: Farklı endometrial kalınlıklarda, hem endometrial kanser hem de endometrial kanser ve endometrial hiperplazi için kabul edilebilir sensitivite, spesitivite, pozitif ve negatif prediktif değerler gösteren bir eşik değer tespit edilemedi ancak, göreli riskin endometrium kanseri için 9.mm.'de, endometrium kanseri + endometrial hiperplazi için 8 mm.'de en yüksek değerde olduğu saptandı. Sonuç: Endometrial biopsi sonuçlarının sistematik incelenmesi, ofis histeroskopi ve transvajinal ultrasonografi endometrial hiperplazi/kanser tespitinde birlikte değerlendirilmelidir.

Anahtar Kelimeler:

Endometriyum, Kanama, Postmenopoz, Ultrasonografi, Tanı teknikleri, kadın doğum ve kadın hastalıkları, Endometriyum neoplazmları

Evaluation of endometrial thickness with transvaginal ultrasonography in postmenopausal bleeding

Objective: In this study, our purpose was to evaluate the sensitivity and spesificity of vaginal ultrasonography as a diagnostic tool for diagnosis of endometrium cancer for postmenopausal bleeding Materials and Methods: Endometrial thickness of the 84 patients with postmenopausal bleeding were mea-sured with vaginal ultrasonography, histopatologic diagnosis were correlated with dilatation and curettage results. For each histopathologic diagnosis, mean endometrial thickness and SD were calculated. With cut off point technic, sensitivity, specificity, positive and negative predictive values were calculated. Results: We didn't find any cut off value for usuable sensitivity, specificity, positive and negative predictivite but the highest level of relative risk was 9 mm. for endometrium cancer and 8 mm. for endometrium cancer + endometrial hyperplasia. Conclusions: Systematic evaluating of endometrial sampling, office histeroscopic and vaginal ultrasonography must be evaluate all together for endometrial hyperplasia and cancer.

Keywords:

Endometrium, Hemorrhage, Postmenopause, Ultrasonography, Diagnostic Techniques, Obstetrical and Gynecological, Endometrial Neoplasms,

___

1. Mac Kenzie İZ, Bibby JG. Critical assesment of dilatation and currettage in 1029 women. Lancet 1978;2:566-568
2. Cooper JM, Ericson ML. Endometrial sampling techniques in the diagnosis of abnormal uterine bleeding.Obstetrics and Gynocology Clinics of North America 2000;27:235-243
3. Gull B, Carlsson SA, Karlsson B, Ylöstalo P, Milsom I. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleed¬ ing : Is it always necessary to perform an endome¬ trial biopsy ? Am J Obstet Gynecol 2000; 182: 509- 515
4. Wolman I, Sagi J, Ginat S, Jaffa A. The sensi¬ tivity and spesitivity of vaginal sonography in detecting endometrial abnormalities in women with postmenopausal bleeding. J Clin Ultrasound 1996;24:79-82
5. Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K.Transvaginal ultrasonography of the endometrium in women with postmenopausal bleed¬ ing- A Nordic multicenter study. Am J Obstet Gynecol 1995; 172: 1488-1499
6. Dorum A, Kristens.en GB, Langebrekke A, Sernes T, Skaar O. Evaluation of endometrial thickness measured by endovaginal ultrasound in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 1993;172:116-119
7. Goldstein SR, Nachtigall M, Snyder JR : Endometrial assesment by vaginal ultrasonography before endometrial sampling in patients with post¬ menopausal women.Br J Obstet Gynecol 1990;163:119-123
8. Granberg S, Wikland M, Karlsson B. Endometrial thickness as measured by endovaginal ultrasonog¬ raphy for identifying endometrial abnormality. Am J Obstet Gynecol 1991;164:47-52 9. Nasri MN, Coast GJ: Correlation of ultrasound findings and endometrial histopathology in post¬ menopausal women. Br J Obstet Gynecol 1989;96:1333~1338 10. Gupta JK, Wilson S, Desaı P,Hav C. How should we investigate women with postmenopausal bleeding? Acta Obstet Gynecol Scand 1996;75:475-479
11. Hulka CA, Hall DA, McCarthy K, Simeone JF
Endometrial polyps, hyperplasia and carcinoma in postmenopausal women: diferentiation with endovaginal sonography. Radiology 1994;191:755- 758 12. Sheikh M, Sawhney S, Kuhurana A. Alteration of sonographic texture of the endometrium in postmenopausal bleeding. Acta Obstet Gynecol Scan 2000;79:1006-1010
13. Fistonic I, Hodek B, Klaric P, Jakanovic L, Gurubisic G, Ivicevic T. Transvaginal sonographic assesment of premalignant and malignant changes in the endometrium in postmenopausal bleeding
J Clin ultrasound 1997;25:431-435
14. Bakour SH, Dwarakanath LS, Khan KS, Newton JR, Gupta JK. The diagnostic accuracy of ultrasound scan in predicting endometrial hyperplasia and cancer in postmenapausal bleeding. Acta Obstet Gynecol Scand 1999;78:447-451
15. Kufahl J, Pedersen I, Sindberg EP, Helkjaer PE, Larsen LG, Jensen KL.Transvaginal ultrasound, endometrial cytology sampled by Gyno scan and histology obtained by uterine explora curette corn- paired to the histology of the uterine speciment.A prospective study in pre and postmenopausal women undergoing elective histerectomy. Acta Obstet Gynecol Scand 1997;76:790-796
16. Büyük E, Durmuşoğlu F, Erenus M,Karakoc B
Endometrial disease diagnosed by transvaginal ultrasound and dilatation and curettage. Acta Obstet Gynecol Scand 1999;78:419-422