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Klinik ve Sonografik Bulguların Endometriyal Histopatolojik Sonucu Öngörmesi

Year 2023, Volume: 56 Issue: 2, 56 - 59, 30.09.2023
https://doi.org/10.20492/aeahtd.688136

Abstract

Amaç: Endometrial patolojilere tanı koymada yaygın olarak kullanılan ve güvenilir olan yöntem endometrial biyopsidir. Daha geniş kitleleri taramak endometrial biyopsi ile mümkün olmadığından; non-invaziv ve daha kolay uygulanabilen bir yöntem olan transvajinal ultrasonografi kullanılmaktadır. Bu çalışmada endometrial biyopsi yapılan hastaların patoloji sonuçları ile ultrasonogrofik bulguları arasındaki ilişkinin incelenmesi amaçlandı.
Gereç ve yöntem: Ocak 2017- Aralık 2018 tarihleri arasında jinekoloji polikliniğine başvuran, postmenopozal dönemde endometrial biyopsi yapılan 761 hasta çalışmaya dahil edildi.
Bulgular: 761 hastanın ortalama yaşı 57 yıl, ortalama postmenopoz süresi ise 7 yıldı. Başvuru anında 428 (% 56.2) hastanın kanama şikayeti vardı, 333 (% 42.8) hasta ise asemptomatikti. Yaş, postmenopozal süre ve endometrial kalınlığın histopatolojik tanı açısından risk faktörü olup olmadığını belirlemek için multivaryant analiz uygulandı. Histopatolojik tanısı yetersiz materyal olan 338 hasta ve endometial kalınlık ölçümü 4 mm den daha az ve asemptomatik 24 hasta analiz dışında bırakıldı ve 399 hasta multivaryant analize dahil edildi. Analiz sonucunda yaş ve postmenopozal sürenin risk faktörü olmadığı (sırasıyla p=0.232, p=0.757 ), endometrial kalınlığın ise bağımsız bir risk faktörü olduğunu bulduk (p=0.024, RR=1.063 (1.008-1.121)).
Sonuç: Çalışmamızın kısıtlılıklarından biri, endometriyal premalign ve malign nedenlerinin analizini sınırlayan retrospektif tasarımda olmasıdır. Bu nedenle, daha büyük prospektif çalışmalar gereklidir ve özellikle asemptomatik postmenopozal kadınlarda endometriyal patoloji riskini arttıracak faktörlerin analizine dayalı bireysel bir değerlendirme yapılmalıdır.
Aim: Endometrial biopsy is a widely used and reliable method for diagnosing endometrial pathologies. Since it is not possible to screen larger societies with endometrial biopsy, transvaginal ultrasonography, which is a non-invasive and easier method, is used. It aimed to examine the relationship between pathology results and ultrasonographic findings of patients who underwent endometrial biopsy in this study.
Material and method: 761 patients who applied to the gynecology outpatient clinic between January 2017 and December 2018 and underwent endometrial biopsy in the postmenopausal period were included in the study.
Results: The mean age of 761 patients was 57 years, and the mean postmenopausal time was 7 years. At the time of admission, 428 (56.2 %) patients had bleeding complaints, and 333 (42.8 %) patients were asymptomatic. Multivariate analysis was performed to determine whether age, postmenopausal duration, and endometrial thickness were risk factors for histopathological diagnosis. 338 patients with histopathological diagnosis of insufficient material and 24 asymptomatic patients with an endometrial thickness measurement of less than 4 mm were excluded from the analysis, and 399 patients were included in the multivariate analysis. As a result of the analysis, we found that age and postmenopausal duration were not risked factors (p=0.232, p=0.757, respectively), while endometrial thickness was an independent risk factor (p=0.024, RR=1.063 (1.008-1.121)).
Conclusion: One of the limitations of our study is that it is a retrospective design that limits the analysis of endometrial premalignant and malignant causes. Therefore, larger prospective studies are required and an individual assessment based on analysis of factors that will increase the risk of endometrial pathology, especially in asymptomatic postmenopausal women.

References

  • van Hanegem N, Breijer MC, Khan KS, et al. Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach. Maturitas. 2011;68(2):155-164. doi:10 .1016/j.maturitas.2010.11.010.
  • Osmers R, Völksen M, Schauer A. Vaginosonography for early dedection of endometrial carcinoma. Lancet 335;1969.
  • WolfmanW, Leyland N, HeywoodM, Singh SS, Rittenberg DA, Soucy R, et al. Asymptomatic endometrial thickening. J Obstet Gynaecol Can 2010;32(10):990–9.
  • Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin 2006;56:11-25.
  • .Endometrial cancer. Practice Bulletin No. 149. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:1006–26.
  • Goldstein SR (1997) The presence of endometrial fluid in asymptomatic postmenopausal women is associated with clinically relevant cervical stenosis. J Ultrasound Med 16(3):208.
  • Takacs P, De Santis T, Nicholas MC, Verma U, Strassberg R, Duthely L (2005) Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease. J Ultrasound Med 24(11):1477–1481.
  • Wong AS, Lao TT, Cheung CW, Yeung SW, Fan HL, Ng PS, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG 2016;123:439-46.
  • Runa Ozelci, Berna Dilbaz, Funda Akpınar, Tugba Kınay, Emre Baser, Oya Aldemir, Sadıman Kıykac Altınbas. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci 2019;62(4):273-279.
  • Kim MJ, Kim JJ, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci 2016;59:192-200.
  • Schmidt T, Breidenbach M, Nawroth F, Mallmann P, Beyer IM, Fleisch MC, et al. Hysteroscopy for asymptomaticpostmenopausal women with sonographically thickened endometrium. Maturitas 2009;62:176-8.
  • The United Kingdom Collaborative Trial of Ovarian Cancer Screening study.
Year 2023, Volume: 56 Issue: 2, 56 - 59, 30.09.2023
https://doi.org/10.20492/aeahtd.688136

Abstract

References

  • van Hanegem N, Breijer MC, Khan KS, et al. Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach. Maturitas. 2011;68(2):155-164. doi:10 .1016/j.maturitas.2010.11.010.
  • Osmers R, Völksen M, Schauer A. Vaginosonography for early dedection of endometrial carcinoma. Lancet 335;1969.
  • WolfmanW, Leyland N, HeywoodM, Singh SS, Rittenberg DA, Soucy R, et al. Asymptomatic endometrial thickening. J Obstet Gynaecol Can 2010;32(10):990–9.
  • Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin 2006;56:11-25.
  • .Endometrial cancer. Practice Bulletin No. 149. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:1006–26.
  • Goldstein SR (1997) The presence of endometrial fluid in asymptomatic postmenopausal women is associated with clinically relevant cervical stenosis. J Ultrasound Med 16(3):208.
  • Takacs P, De Santis T, Nicholas MC, Verma U, Strassberg R, Duthely L (2005) Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease. J Ultrasound Med 24(11):1477–1481.
  • Wong AS, Lao TT, Cheung CW, Yeung SW, Fan HL, Ng PS, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG 2016;123:439-46.
  • Runa Ozelci, Berna Dilbaz, Funda Akpınar, Tugba Kınay, Emre Baser, Oya Aldemir, Sadıman Kıykac Altınbas. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci 2019;62(4):273-279.
  • Kim MJ, Kim JJ, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci 2016;59:192-200.
  • Schmidt T, Breidenbach M, Nawroth F, Mallmann P, Beyer IM, Fleisch MC, et al. Hysteroscopy for asymptomaticpostmenopausal women with sonographically thickened endometrium. Maturitas 2009;62:176-8.
  • The United Kingdom Collaborative Trial of Ovarian Cancer Screening study.
There are 12 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original research article
Authors

Deniz Oluklu

Yusuf Ustun

Hasan Uçkan This is me

Ayşe Hazırbulan

Osman Aydın

Publication Date September 30, 2023
Submission Date February 11, 2020
Published in Issue Year 2023 Volume: 56 Issue: 2

Cite

AMA Oluklu D, Ustun Y, Uçkan H, Hazırbulan A, Aydın O. Klinik ve Sonografik Bulguların Endometriyal Histopatolojik Sonucu Öngörmesi. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. September 2023;56(2):56-59. doi:10.20492/aeahtd.688136