Transvaginal ultrasonography and office hysteroscopic findings and their histopathologic correlation in asymptomatic and symptomatic postmenopausal women

• Published in: Medical journal of Bakirköy Vol. 3; no. 2; pp. 68 - 72
• Main Authors: EKİN, Murat, KARAYALÇIN, Rana, ÖZCAN, Sarp, ÖZCAN, Uyku
• Format: Journal Article
• Language: English
• Published: Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi 2007
• ISSN: 1305-9319

Amaç: postmenapozal asemptomatik ve semptomatik hormonoreapi (HRT) alan ve almayan hastalarda transvajinal ultrasonografi ve ofis histeroskopinin histopatolojik sonuçlarla korelasyonunun değerlendirilmesi. Gereç ve Yöntem: Anormal endometrial kalınlık tespit edilen 80 asemptomatik ve 70 semptomatik postmenapozal toplam 150 hastaya ofis histeroskopi uygulandı. Endometrial kalınlık HRT almayanlarda 5 mm ve HRT alanlarda 8mm üzerinde anormal olarak kabul edildi Her hastaya histeroskopi sonrası endometrial biyopsi uygulandı. Transvajinal ultrasonografi ve ofis histeroskopi bulguları histopatolojik tanılarla karşılaştırıldı. Bulgular: Toplam 150 hastadan 96'sı hormon replasman tedavisi almazken (%64), 54'ü (%36) hormon replasman tedavisi almaktaydı. Hastalardan 80'i (%53.3) asemptomatik, 70'i (%46.7) semptomatikti. Transvajinal ultrasonografi %28.7'sinde normal bulundu. Anormal endometrial kalınlık %55.3 hastada tespit edildi. Histeroskopik değerlendirmede hastaların %15.3'ü normaldi. Endometrial polip en sık gözlenen anormal görünümdü (%27.3). Endometrial polip asemptomatik grupta en sık gözlenen histopatoloji tanı iken semptomatik grupta endometrial hiperplazi ve atrofik endometrium tanısı gözlendi. Endometrial hiperplazi tanısı 3 asemptomatik ve 10 semptomatik hastada tespit edildi. Ofis histeroskopinin edometrial hiperplazi tanı sı için prediktivitesi %58.8 olarak saptandı. Asemptomatik hastalar HRT almıyordu ve bu hastalar histeroskopik gözlemde endometrial polip olarak değerlendirildi. Semptomatik hastaların transvajinal ultrasonografilerinde endometrial kalınlık hepsinde anormal olarak değerlendirildi. Histeroskopik incelemelerinde tüm olgular patolojik inceleme ile uyumlu olarak hiperplastik endometrial değişklikler olarak değerlendirildi. Sonuç: Endometrial polip transvajinal utrasonografide anormal endometrial kalınlık tespit edilen asemptomatik hastalardaki en sık bulgu olarak görülmektedir. Ofis histeroskopi semptomatik hastalarda endometriayal hiperplazinin tespitinde yüksek sensitiviteye sahip görülmekle birlikte asemptomatik hastalarda histeroskopide endometrial polip gibi yanlış negatif sonuçlar tespit edilebilir. Endometriyal biyopsi bu nedenle halen transvajinal ultrasonda anormal enometriyal kalınlık tespit edilen hastalarda gerekmektedir. Objective: To investigate the role of ultrasonography and office hysteroscopy in the diagnosis of endometrial status with the correlation of histopathologic findings in symptomatic and asymptomatic group of menopausal patients with hormone replacement therapy (HRT) users and non users. Material and Methods: Asymptomatic 80 patients with abnormal endometrial thickness and 70 patients with postmenopausal uterine bleeding were undergone office hysteroscopy. Endometrial thickness was diagnosed as abnormal with more than 8 milimeters in HRT users and 5 milimeters in non-users respectively. All 150 patients were evaluated with office hysteroscopy. Endometrial sampling was carried out in all cases. Transvaginal ultrasonograpy and office hysteroscopy procedures were correlated with the histopathologic findings. Results: 96 of the patients (64%) were not using HRT and 54 of them (36%) were using HRT. 80 (53.3%) of the patients were asymptomatic while 70 (46.7%) of them were symptomatic. Transvaginal ultrasonograpy were normal in 28.7% of the patients. Abnormal thickness of the endometrium was found in 55.3% of cases. At hysteroscopic evaluation 15.3% of the patients were normal. Endometrial polyp (27.3%) was the most significant abnormal finding. Endometrial polyp (51.3%) was the most significant hystopathologic diagnosis in the asymptomatic group while 14.3% of cases had hyperplasia and 34.3% of cases atrophic endometrium was found in the symptomatic group. Endometrial hyperplasia was diagnosed at 3 asymptomatic and 10 symptomatic patients. Over all predictivity of office hysteroscopy for endometrial hyperplasia was 58.8%. Asymptomatic patients were non HRT users and hysteroscopic finding was endometrial polyp in all cases. Endometrial thickness was all abnormal in symptomatic patients. Hysteroscopic diagnosis was hyperplastic endometrium in all of the cases. Conclusion: Endometrial polyps are the most common finding at hysteroscopy in asymptomatic patients with abnormal endometrial thickness in transvaginal ultrasonograpy. Office hysteroscopy is highly sensitive in symptomatic patients though false negative diagnosis such as polyps is common in asymptomatic patients and endometrial biopsy is still indicated in patients with abnormal endometrial thickness in transvaginal ultrasound.