Anormal uterin kanaması olan hastaların tanısında transvaginal ultrasonografi ve ofis histeroskopinin yeri
Öz
Amaç: Bu çalışmanın amacı anormal uterin kanaması olan kadınlarda endometrial patolojilerin saptanmasında transvaginal ultrasonografi (TvUSG) ve ofis histeroskopinin tanıdaki etkinliğini belirlemektir.
Gereç ve Yöntemler: Bu retrospektif çalışmada, anormal uterin kanama şikâyeti ile başvuran toplam 59 hastanın sonuçları değerlendirildi. Tüm hastalara pelvik muayene, transvajinal ultrasonografi, ofis histeroskopi ve endometrial biopsi sonuçları kaydedildi. Değerlendirme yapılırken transvajinal ultrasonografi ve ofis histeroskopi bulguları endometrial biopsi tanıları ile karşılaştırıldı. Her iki yöntemin; sensitivite, spesifite, PPD ve NPD’ler hesaplandı. Ayrıca TvUSG ve histeroskopinin tanıdaki etkinliğini belirlemek için ROC analizi yapıldı.
Bulgular: Çalışmaya alınan hastaların ortalama yaşı 47.2±9.94 ve %32,2 (n=19) postmenopozal dönemdeydi. TvUSG’nin Endometriyal patolojilerin tanısında ki; sensitivitesi %53,5, spesifisitesi %43,7, PPD %71,8 ve NPD %25,9 olarak bulundu. Ofis Histeroskopinin ise endometrial patolojileri tespit etmedeki sensivitesi % 79, spesifitesi % 87.5, PPD %94.4 ve NPD %60.8 olarak bulundu. TvUSG’nin endometriyal poliplerde sensitivitesi %48,5 spesifisitesi %64,2, PPD %61,5, NPD %51,4. Submuköz myomlarda sensitivitesi %100,0, spesifisitesi %98,1, PPD %83,3, NPD %100,0 olarak bulundu. Ofis Histeroskopinin endometrial poliplerde sensitivitesi %78,8, spesifisitesi %93,9, PPD %92,8, NPD %81,5. Submuköz myomlarda sensitivitesi %100,0, spesifisitesi %94,4, PPD %62,5, NPD %100,0 olarak bulundu.
Sonuç: Ofis histeroskopinin intrauterin kavitedeki polip ve submüköz myom gibi anormalliklerin saptanmasında tanısal doğruluğu TvUSG’den üstündür. Anormal uterin kanamalı kadınların değerlendirilmesinde histeroskopi eşliğinde yapılan endometrial biopsi en doğru sonucun elde edilmesini sağlar.
Anahtar Kelimeler
transvaginal ultrasonografi ofis histeroskopi anormal uterin kanama endometrial polip
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
Yazarlar araştırmaya data toplama aşamasında katkıda bulunan ancak yazar olarak atanmayan Göztepe Eğitim ve Araştırma Hastanesi, Kadın hastalıkları ve Doğum Bölümü çalışanlarına katkılarından dolayı teşşekkür eder.
Kaynakça
- 1. Wieser F, Tempfer C, Kurz C, Nagele F. Hysteroscopy in 2001: a comprehensive review. Acta Obstet Gynecol Scand. 2001 Jan 1;80(9):773–83.
- 2. Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018;143(3):393–408.
- 3. Shwayder JM. Pathophysiology of abnormal uterine bleeding. Obstet Gynecol Clin North Am. 2000 Jun 1;27(2):219–34.
- 4. Nesse RE. Abnormal vaginal bleeding in perimenopausal women. Am Fam Physician. 1989;40(1):185.
- 5. Grimes DA. Diagnostic dilation and curettage: A reappraisal. Am J Obstet Gynecol. 1982 Jan 1;142(1):1–6.
- 6. Dijkhuizen FPHLJ, Brölmann HAM, Potters AE, Bongers MY, Heintz APM. The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gynecol. 1996 Mar 1;87(3):345–9.
- 7. Yela DA, Hidalgo SR, Pereira KC, Gabiatti JR, Monteiro IM. Comparative study of transvaginal sonography and outpatient hysteroscopy for the detection of intrauterine diseases. Acta Med Port. 2011;24:65–70.
- 8. Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage: A review of 276 cases. Am J Obstet Gynecol. 1988 Mar 1;158(3, Part 1):489–92.
- 9. Wanderley M da S, Álvares MM, Vogt M de FB, Sazaki LMP, Wanderley M da S, Álvares MM, et al. Accuracy of Transvaginal Ultrasonography, Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies. Rev Bras Ginecol E Obstetrícia. 2016 Oct;38(10):506–11.
- 10. Kasraeian M, Asadi N, Ghaffarpasand F, Karimi AA. Value of transvaginal ultrasonography in endometrial evaluation of non-bleeding postmenopausal women. Climacteric. 2011;14(1):126–31.
- 11. Pal L, Lapensee L, Toth TL, Isaacson KB. Comparison of office hysteroscopy, transvaginal ultrasonography and endometrial biopsy in evaluation of abnormal uterine bleeding. JSLS. 1997;1(2):125.
- 12. Hidlebaugh D. A comparison of clinical outcomes and cost of office versus hospital hysteroscopy. J Am Assoc Gynecol Laparosc. 1996 Nov 1;4(1):39–45.
- 13. Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril. 2005;84(3):682–6.
- 14. Dreisler E, Sorensen SS, Ibsen PH, Lose G. Value of endometrial thickness measurement for diagnosing focal intrauterine pathology in women without abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2009;33(3):344–8.
- 15. Babacan A, Gun I, Kizilaslan C, Ozden O, Muhcu M, Mungen E, et al. Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies. Int J Clin Exp Med. 2014;7(3):764.
- 16. Grimes DA. Estimating vaginal blood loss. J Reprod Med. 1979;22(4):190–2.
- 17. Fraser IS, McCarron G, Markham R. A preliminary study of factors influencing perception of menstrual blood loss volume. Am J Obstet Gynecol. 1984;149(7):788–93.
- 18. Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod Oxf Engl. 1997;12(8):1768–71.
- 19. Aslam M, Ijaz L, Tariq S, Shafqat K. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci. 2007;1(1):17.
The role of transvaginal ultrasonography and office hysteroscopy in the diagnosis of patients with abnormal uterine bleeding
Öz
Aim: The aim of this study is to evaluate the role of office hysteroscopy and transvaginal ultrasonography (TvUSG) in the assessment of endometrial cavity of patients with abnormal uterine bleeding.
Materials and Methods: In this retrospective study, a total of 59 patients who had abnormal uterine bleeding were evaluated. All of the patients underwent pelvic examination, transvaginal ultrasonography, office hysteroscopy and endometrial biopsy. During the evaluation, transvaginal ultrasonography and office hysteroscopy findings were compared with endometrial biopsy results. Both transvaginal ultrasonography and office hysteroscopy methods; the sensitivity, specificity, PPD and NPDs were calculated. In addition, ROC analysis was performed for TvUSG and office hysteroscopy.
Results: The mean age of the patients was 47.2 ± 9.94 and 32.2% (n = 19) were in the postmenopausal period. The sensitivity of TvUSG in the diagnosis of endometrial pathologies was 53.5%, specificity 43.7%, PPD 71.8%, NPD 25.9%. The sensitivity of office hysteroscopy in detecting endometrial pathologies was 79.0%, specificity 87.5%, PPD 94.4% and NPD 60.8%. The sensitivity of TvUSG in endometrial polyps was 48.5%, specificity was 64.2%, PPD 61.5%, NPD 51.4%. The sensitivity of TvUSG in leiomyomas was 100.0%, specificity was 98.1%, PPD was 83.3%, and NPD was 100.0%. The sensitivity of office hysteroscopy in leiomyomas was 78.8%, specificity 93.9%, PPD 92.8%, NPD 81.5%. The sensitivity of office hysteroscopy in endometrial polyps was 100.0%, specificity 94.4%, PPD 62.5% and NPD 100.0%
Conclusion: The sensitivity and specificity of office hysteroscopy in detection of intrauterine abnormalities such as polyps and submucous leiomyoma, is higher than the TvUSG. In the evaluation of endometrial pathology, combine of office hysteroscopy with endometrial sampling has the best diagnostic accuracy.
Anahtar Kelimeler
transvaginal ultrasonography office hysteroscopy abnormal uterine bleeding endometrial polyp
Proje Numarası
yok
Kaynakça
- 1. Wieser F, Tempfer C, Kurz C, Nagele F. Hysteroscopy in 2001: a comprehensive review. Acta Obstet Gynecol Scand. 2001 Jan 1;80(9):773–83.
- 2. Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018;143(3):393–408.
- 3. Shwayder JM. Pathophysiology of abnormal uterine bleeding. Obstet Gynecol Clin North Am. 2000 Jun 1;27(2):219–34.
- 4. Nesse RE. Abnormal vaginal bleeding in perimenopausal women. Am Fam Physician. 1989;40(1):185.
- 5. Grimes DA. Diagnostic dilation and curettage: A reappraisal. Am J Obstet Gynecol. 1982 Jan 1;142(1):1–6.
- 6. Dijkhuizen FPHLJ, Brölmann HAM, Potters AE, Bongers MY, Heintz APM. The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gynecol. 1996 Mar 1;87(3):345–9.
- 7. Yela DA, Hidalgo SR, Pereira KC, Gabiatti JR, Monteiro IM. Comparative study of transvaginal sonography and outpatient hysteroscopy for the detection of intrauterine diseases. Acta Med Port. 2011;24:65–70.
- 8. Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage: A review of 276 cases. Am J Obstet Gynecol. 1988 Mar 1;158(3, Part 1):489–92.
- 9. Wanderley M da S, Álvares MM, Vogt M de FB, Sazaki LMP, Wanderley M da S, Álvares MM, et al. Accuracy of Transvaginal Ultrasonography, Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies. Rev Bras Ginecol E Obstetrícia. 2016 Oct;38(10):506–11.
- 10. Kasraeian M, Asadi N, Ghaffarpasand F, Karimi AA. Value of transvaginal ultrasonography in endometrial evaluation of non-bleeding postmenopausal women. Climacteric. 2011;14(1):126–31.
- 11. Pal L, Lapensee L, Toth TL, Isaacson KB. Comparison of office hysteroscopy, transvaginal ultrasonography and endometrial biopsy in evaluation of abnormal uterine bleeding. JSLS. 1997;1(2):125.
- 12. Hidlebaugh D. A comparison of clinical outcomes and cost of office versus hospital hysteroscopy. J Am Assoc Gynecol Laparosc. 1996 Nov 1;4(1):39–45.
- 13. Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril. 2005;84(3):682–6.
- 14. Dreisler E, Sorensen SS, Ibsen PH, Lose G. Value of endometrial thickness measurement for diagnosing focal intrauterine pathology in women without abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2009;33(3):344–8.
- 15. Babacan A, Gun I, Kizilaslan C, Ozden O, Muhcu M, Mungen E, et al. Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies. Int J Clin Exp Med. 2014;7(3):764.
- 16. Grimes DA. Estimating vaginal blood loss. J Reprod Med. 1979;22(4):190–2.
- 17. Fraser IS, McCarron G, Markham R. A preliminary study of factors influencing perception of menstrual blood loss volume. Am J Obstet Gynecol. 1984;149(7):788–93.
- 18. Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod Oxf Engl. 1997;12(8):1768–71.
- 19. Aslam M, Ijaz L, Tariq S, Shafqat K. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci. 2007;1(1):17.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | MAKALELER |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 27 Kasım 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 4 Sayı: 3 |
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