Postmenopozal semptomatik ve asemptomatik olgularda transvaginal ultrasonografi ile ölçülen endometriyal kalınlık ile histopatoloji sonuçlarının karşılaştırılması
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2013
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Maltepe Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Günümüzde postmenopozal kadınların yaşam kalitesi ve bunun sonucu olarak yaşam sürelerinin artması nedeniyle daha çok postmenopozal dönemde görülen endometriyum ve over kanseri vakaları da artmaktadır. Endometriyum kanseri kadın genital yolunun en sık görülen malignansisidir ve kansere bağlı ölümlerin 8. en sık sebebidir. Postmenopozal kanamayla başvuran hastaların yaklaşık % 10' unda endometriyum kanseri saptanmaktadır, en erken belirtisi olması nedeniyle tüm postmenopozal kanamalar dikkatle değerlendirilmelidir.Transvaginal ultrasonografi (TVUSG) endometriyal kavite morfolojisini ve endometriyal kalınlığı değerlendirmede oldukça etkili, hızlı, güvenilir, genellikle ağrısız ve göreceli olarak non invaziv sayılabilecek bir yöntemdir (73).Bu çalışma postmenopozal vaginal kanaması olan ve asemptomatik olup endometriyal kalınlık saptanan olgularda, transvaginal ultrasonografik bulguları ve histopatolojik bulguları karşılaştırarak TVUSG'nin endometriyal patolojilerin değerlendirilmesindeki güvenilirliğini araştırmak amacıyla yapılmıştır.MATERYAL VE METODBu çalışma, T.C. Maltepe Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Polikliniklerimize Temmuz 2010- Eylül 2012 tarihleri arasındaki 27 aylık dönemde vaginal kanama şikayeti ile başvuran 100 ve rutin kontrolleri için başvuran asemptomatik 29 postmenopozal kadının, bilgisayar, dosya kayıtları ve patoloji kayıtları incelenerek retrospektif olarak yapıldı. Transvaginal ultrasonografi incelemesi Logiq pro 200 serisi, yüksek rezolusyonlu 6,5 MHz transvaginal problu bir ultrason cihazıyla yapıldı. Endometriyal kalınlık ölçümlerinde cut-off değer 5 mm olarak alındı. Endometriyum kalınlığından bağımsız olarak tüm postmenopozal kanamalı hastalar ve asemptomatik hastalarda 5 mm'nin üstü değerler ve intrakaviter koleksiyonu olan vakalar patolojik olarak değerlendirildi. Hastalar endometriyal kalınlıklarına göre gruplara ayrıldı.BULGULARÇalışmamızda endometriyum kalınlıklarına göre hastalar 3 gruba ayrıldığında, endometriyum kalınlığı 15 mm ve üzeri olanlarda endometriyum kalınlığı 5 mm'in altında olanlara ve 5-14,99 mm arasında olanlara göre kanser oranı istatistiksel olarak anlamlı derecede daha yüksek bulundu (p<0,05). Endometriyum kalınlığı 15 mm ve üzeri olanlarda endometriyum kalınlığı 15 mm'in altında olanlara göre kanser 3,043 kat (%95 Cİ:1,168-7,930) daha yüksek oranda saptandı.Çalışmamızda endometriyum kalınlığı 20mm ve üzeri olan hastaların %81,3'ünde kanama semptomu mevcut olup (16 hastanın 13'ünde kanama mevcut, 3'ünde kanama yok) kanaması olan ve endometriyumu 20mm'in üzerindeki bu hastaların %53,8'inde kanser saptanmıştır. Bu oran kanamalı ve endometriyum kalınlığı 15mm ve üzeri olan hastalar için %34,6'dır. Endometriyum kalınlığı 5mm'in altında olan hastaların %75'inde atrofik endometriyum saptanmış olup hiç kanser vakası saptanmamıştır. Kanser saptananlarda kanser saptanmayanlara göre endometriyal kalınlık istatistiksel olarak anlamlı derecede daha fazla saptandı (p<0,05).Çalışmamızda aynı kalınlık grupları içerisinde kanama ile kanser ilişkisi incelendiğinde ve endometriyum kalınlıklarına göre hastalar 3 gruba ayrıldığında endometriyum kalınlığı 15 mm ve üzerinde olan grupta da kanama olanlarda kanama olmayanlara göre kanser oranı daha yüksek olmakla birlikte, çalışmamıza göre 5-14,99 mm olan grupta kanama olanlarda kanama olmayanlara göre kanser oranı istatistiksel olarak anlamlı derecede yüksek saptandı (p<0,05).Bizim çalışmamızda Hipertansiyon (HT) olanlarda HT olmayanlara göre kanser daha yüksek oranda saptanmasına rağmen istatistiksel olarak anlamlı farklılık bulunmadı (p>0,05). Diyabetes Mellitus (DM) olanlarda DM olmayanlara göre kanser istatistiksel olarak 3 kat daha yüksek oranda tespit edildi (p<0,05) (OR:3,012 %95 Cİ:1,131-8,017).TARTIŞMA VE SONUÇSonuç olarak, postmenopozal dönemdeki endometriyal kalınlık artışı endometriyal patolojileri düşündürecek önemli bir bulgudur. Postmenopozal kanama şikayeti ile başvuran hastalara da ayrıntılı jinekolojik muayene yapılmalı ve endometriyum TVUSG ile değerlendirilmelidir. TVUSG postmenopozal dönemdeki endometriyal patolojilerin tanısında etkin ve kabul edilebilir non invaziv bir yöntemdir ve erken tanının prognoz üzerindeki olumlu etkisi bilindiği üzere, endometriyum kanseri açısından riskli kadınların tanımlanmasında ve takibinde çok önemlidir.TVUSG' de endometriyal kalınlık artışı saptandıysa hasta asemptomatik de olsa endometriyal biopsi için yönlendirilmelidir. Özellikle postmenopozal kanaması olan hastalarda kalın endometriyum da eşlik eden bulgu ise olası endometriyal maligniteyi ekarte etmek için endometriyal biopsi mutlaka yapılmalıdır. Bizim çalışmamızın da TVUSG'nin asemptomatik ve semptomatik postmenopozal kadınlarda rutin kanser tarama yöntemi olarak kullanılabilmesi konusunda ciddi bir destek olduğunu düşünmekteyiz.
ABSTRACTOBJECTIVEAs a result of the increase in quality of life and life expectancy, the incidence of endometrial and ovarian cancer has increased recently in postmenopausal period. Endometrial carcinoma is the most common genital cancer in women and eighth leading cause of death due to cancers. Endometrial cancer is diagnosed in approximately 10% of patients with postmenopausal bleeding. Because bleeding is the earliest symptom, all women presenting with postmenopausal bleeding should undergo further evaluation.Transvaginal ultrasonography (TVUSG) can reliably assess endometrial thickness and uterine cavity morphology. It?s a safe, rapid, highly effective, generally painless and relatively less invasive method.The aim of this study was to investigate the reliability of TVUSG in endometrial pathologies by comparising the ultrasonographic and histopathologic findings in symptomatic and asymptomatic (bleeding-free, with sonographically thickened endometrium) postmenopausal women.MATERİALS AND METHODSIn this study, we retrospectively reviewed the data of 129 postmenopausal women, referred to the Department of Obstetric and Gynecology at Maltepe University Faculty of Medicine between July 2010 and September 2012. 100 of them were sypmtomatic and 29 of them were not. TVUSG ( Logiq pro 200, with the high-frequency vaginal transducer of 6,5 MHz ) was performed in all women. The cut off level was accepted as 5mm. The patients were divided in groups according to the value of endometrial thickness. All women with postmenopausal bleeding, irrespective to their endometrial thickness, and asymptomatic women with thickened endometrium of 5mm and more than 5mm, were accepted as pathologic. Dilatation and curettage was performed in these patients.RESULTSIn our study as we divided the patients according to their endometrial thickness in 3 groups, the rate of the cancer was found significantly higher in patients with the endometrial thickness of 15mm and more, than the other two groups with the endometrial thickness of less than 5mm and 5-14,99mm (p<0,05). The rate of the cancer was found statistically 3,043 times (%95 CI:1,168-7,930) higher in patients with the endometrial thickness of 15mm and more, than in patients, less than 15mm.In our study, the symptom of bleeding was present in 81,3% of patients with the endometrial thickness of 20mm and more. Cancer was diagnosed in 53,8% of these patients. Cancer was diagnosed in 34,6% of the symptomatic patients with the endometrial thickness of 15mm and more.Atrophic endometrium was detected in 75% of the patients with the endometrial thickness of less than 5mm and none of them were diagnosed as cancer. Endometrial thickness was found significantly higher in cancer patients than the others (p<0,05).In this study when we compared the groups with the same endometrial thickness, we found that the rate of the cancer was significantly higher in the symptomatic patients with the endometrial thickness of 5-14,99mm than the asymptomatic ones with the same thickness range.Despite the rate of the cancer was found higher in the patients with Hypertension (HT) than in non hypertensive ones, it wasn?t found statistically significant in our study (p>0,05). The rate of the cancer was found statistically 3,012 times higher in patients with Diabetes Mellitus (DM) than in non diabetic ones (p<0,05) (OR:3,012 %95 CI:1,131-8,017).DISCUSSION AND CONCLUSIONSThe increase of the endometrial thickness in postmenopausal women, is an important sign of the endometrial pathologies. The patients with postmenopausal bleeding should undergo detailed gynecological examination and TVUSG should be performed. TVUSG is an effective and non invaziv method for the diagnosis and follow up of the patients who are under the high risk of endometrial cancer.As the endometrial thickness is found 5mm and more, endometrial biopsy is advised even if the patient is asymptomatic. Furthermore if the patient is symptomatic with a thick endometrium, to exclude the malignancy endometrial biopsy must be performed. We think that our study may be another strong support to the success of TVUSG as a screening method in both symptomatic and asymptomatic postmenopausal women.
ABSTRACTOBJECTIVEAs a result of the increase in quality of life and life expectancy, the incidence of endometrial and ovarian cancer has increased recently in postmenopausal period. Endometrial carcinoma is the most common genital cancer in women and eighth leading cause of death due to cancers. Endometrial cancer is diagnosed in approximately 10% of patients with postmenopausal bleeding. Because bleeding is the earliest symptom, all women presenting with postmenopausal bleeding should undergo further evaluation.Transvaginal ultrasonography (TVUSG) can reliably assess endometrial thickness and uterine cavity morphology. It?s a safe, rapid, highly effective, generally painless and relatively less invasive method.The aim of this study was to investigate the reliability of TVUSG in endometrial pathologies by comparising the ultrasonographic and histopathologic findings in symptomatic and asymptomatic (bleeding-free, with sonographically thickened endometrium) postmenopausal women.MATERİALS AND METHODSIn this study, we retrospectively reviewed the data of 129 postmenopausal women, referred to the Department of Obstetric and Gynecology at Maltepe University Faculty of Medicine between July 2010 and September 2012. 100 of them were sypmtomatic and 29 of them were not. TVUSG ( Logiq pro 200, with the high-frequency vaginal transducer of 6,5 MHz ) was performed in all women. The cut off level was accepted as 5mm. The patients were divided in groups according to the value of endometrial thickness. All women with postmenopausal bleeding, irrespective to their endometrial thickness, and asymptomatic women with thickened endometrium of 5mm and more than 5mm, were accepted as pathologic. Dilatation and curettage was performed in these patients.RESULTSIn our study as we divided the patients according to their endometrial thickness in 3 groups, the rate of the cancer was found significantly higher in patients with the endometrial thickness of 15mm and more, than the other two groups with the endometrial thickness of less than 5mm and 5-14,99mm (p<0,05). The rate of the cancer was found statistically 3,043 times (%95 CI:1,168-7,930) higher in patients with the endometrial thickness of 15mm and more, than in patients, less than 15mm.In our study, the symptom of bleeding was present in 81,3% of patients with the endometrial thickness of 20mm and more. Cancer was diagnosed in 53,8% of these patients. Cancer was diagnosed in 34,6% of the symptomatic patients with the endometrial thickness of 15mm and more.Atrophic endometrium was detected in 75% of the patients with the endometrial thickness of less than 5mm and none of them were diagnosed as cancer. Endometrial thickness was found significantly higher in cancer patients than the others (p<0,05).In this study when we compared the groups with the same endometrial thickness, we found that the rate of the cancer was significantly higher in the symptomatic patients with the endometrial thickness of 5-14,99mm than the asymptomatic ones with the same thickness range.Despite the rate of the cancer was found higher in the patients with Hypertension (HT) than in non hypertensive ones, it wasn?t found statistically significant in our study (p>0,05). The rate of the cancer was found statistically 3,012 times higher in patients with Diabetes Mellitus (DM) than in non diabetic ones (p<0,05) (OR:3,012 %95 CI:1,131-8,017).DISCUSSION AND CONCLUSIONSThe increase of the endometrial thickness in postmenopausal women, is an important sign of the endometrial pathologies. The patients with postmenopausal bleeding should undergo detailed gynecological examination and TVUSG should be performed. TVUSG is an effective and non invaziv method for the diagnosis and follow up of the patients who are under the high risk of endometrial cancer.As the endometrial thickness is found 5mm and more, endometrial biopsy is advised even if the patient is asymptomatic. Furthermore if the patient is symptomatic with a thick endometrium, to exclude the malignancy endometrial biopsy must be performed. We think that our study may be another strong support to the success of TVUSG as a screening method in both symptomatic and asymptomatic postmenopausal women.
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Ulu, İ. (2013). Postmenopozal semptomatik ve asemptomatik olgularda transvaginal ultrasonografi ile ölçülen endometriyal kalınlık ile histopatoloji sonuçlarının karşılaştırılması / The comparison of the endometrial thickness measured by transvaginal ultrasonography with the histopathology results in symptomatic and asymptomatic postmenopausal cases (Yayımlanmamış Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
