Postmenopozal hastalarda endometrial örnekleme sonuçlarının değerlendirilmesi; yetersiz endometrial örneklemenin önemi
Abstract
Amaç
Postmenopozal hasta populasyonunda endometrial örnekleme sonuçlarının değerlendirilmesi ve yetersiz endometrial örnekleme sıklığının belirlenmesi amaçlanmıştır.
Gereç ve Yöntem Bu retrospektif çalışmada Bursa Şehir Hastanesi kadın hastalıkları ve doğum bölümüne Temmuz 2019 ve Mart 2021 tarihleri arasında başvuran postmenopozal dönemdeki 825 hastadan alınan endometrial biyopsi sonuçları değerlendirilmiştir.
Bulgular Postmenopozal dönemde olan 825 hastadan alınan 922 endometrial örnekleme sonucu değerlendirildi. Hastaların yaş ortalaması 56.96±7.21 olup, ortalama menopoz süresi 7.43±7.14 yıldır. Hastalardan alınan 1. endometrial örneklemenin histopatolojik değerlendirmesi yapıldığında 25.45 % yetersiz endometrial örneklemeye rastlanırken postmenopozal kanama şikayeti ile başvuran hasta grubunda ise bu oran %21.61 dir. En sık endometrial patoloji endometrial polip (22.1%) olup çalışma grubumuzda malignite sıklığı %6.18 idi. Alt grup analizlerde malignite görülme sıklığı >60 yaş grubunda daha yüksek (%18.80) iken yaş ile birlikte yetersiz endometrial örneklemenin de arttığı belirlenmiştir. Birinci endometrial örnekleme sonucu yetersiz olan hastaların sadece %20 sinden tekrar biyopsi alınabilmiştir. Bu hastalardan 3 ünde endometrium kanseri ve 1 hastada atipili endometrial hiperplazi varlığı tespit edilmiştir.
Sonuç
Artan yaş ile birlikte endometrium kanseri sıklığı artmasına rağmen yetersiz endometrial örneklemenin de arttığı gözlenmiştir. Özellikle bu hasta populasyonunda endometrium kanseri risk faktörlerini de göz önünde bulundurarak takiplere gelmesi konusunda yeterli bilgilendirmenin yapılması önem taşımaktadır.
References
- 1. Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1996;866:1-107
- 2. Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol 1995;172:1488-94
- 3. Wolfman, W. No. 249-Asymptomatic Endometrial Thickening. Journal of Obstetrics and Gynaecology Canada, 40(5), e367–e377. 2018. doi:10.1016/j.jogc.2018.03.005
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- 5. van Hanegem N, Prins MM, Bongers MY, Opmeer BC, Sahota DS, Mol BW, Timmermans A. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016 Feb;197:147-55. doi: 10.1016/j.ejogrb.2015.12.008
- 6. Aue-Aungkul A, Kleebkaow P, Kietpeerakool C. Incidence and risk factors for insufficient endometrial tissue from endometrial sampling. Int J Womens Health. 2018 Aug 15;10:453-457. doi: 10.2147/IJWH.S172696
- 7. Ewies AA, Shaaban KA, Merard R, Zanetto U. Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant. J Clin Pathol. 2014 Aug;67(8):673-7. doi: 10.1136/jclinpath-2014-202210
- 8. Ateş S, Gökmen Karasu AF, Çalı H, Soyman Z, Uysal Ö. Factors Associated with Insufficient Endometrial Sampling in Postmenopausal Women. Med Bull Haseki 2020;58:65-71
- 9. van Doorn HC, Opmeer BC, Burger CW, Duk MJ, Kooi GS, Mol BW; Dutch Study in Postmenopausal Bleeding (DUPOMEB). Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results. Int J Gynaecol Obstet. 2007 Nov;99(2):100-4. doi:10.1016/j.ijgo.2007.05.040
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- 11. ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018 May;131(5):e124-e129. doi: 10.1097/AOG.0000000000002631
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- 18. Tumrongkunagon S, Suknikhom W. Histological Sampling of Endometrial Tissue: Comparison between the MedGyn® Endosampler and Formal Fractional Curettage in Patients with Abnormal Uterine Bleeding. Asian Pac J Cancer Prev. 2019;20(11):3527-3531. Published 2019 Nov 1. doi:10.31557/APJCP.2019.20.11.3527
- 19. Xie B, Qian C, Yang B, Ning C, Yao X, Du Y et al. Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy (Pipelle) and Diagnostic Dilation and Curettage. J Minim Invasive Gynecol. 2018 May-Jun;25(4):724-729. doi: 10.1016/j.jmig.2017.11.018
- 20. Selvaggi L, Cormio G, Ceci O, Loverro G, Cazzolla A, Bettochi S. Hysteroscopy does not increase the risk of microscopic extrauterine spread in endometrial carcinoma. Int J Gynecol Cancer 2003;13:223-7
- 21. Munro MG; Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J. 2014 Winter;18(1):55-70. doi: 10.7812/TPP/13-072
- 22. Schmidt T, Breidenbach M, Nawroth F, Mallmann P, Beyer I M, Fleisch M C et al. Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium. Maturitas;2009, 62(2), 176–178. doi:10.1016/j.maturitas.2008.11.018
- 23. Korkmazer E, Solak N, Üstünyurt E. Hysteroscopic assessment of postmenopausal endometrial thickening. Prz Menopauzalny. 2014 Dec;13(6):330-3. doi: 10.5114/pm.2014.47985
- 24. Ozelci R, Dilbaz B, Akpınar F, Kınay T, Baser E, Aldemir O et al. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci. 2019 Jul;62(4):273-279. doi: 10.5468/ogs.2019.62.4.273
- 25. Trojano G, Damiani GR, Casavola VC, Loiacono R, Malvasi A, Pellegrino A et al. The Role of Hysteroscopy in Evaluating Postmenopausal Asymptomatic Women with Thickened Endometrium. Gynecol Minim Invasive Ther. 2018 Jan-Mar;7(1):6-9. doi: 10.4103/GMIT.GMIT_10_17
Evaluation of endometrial sampling results in postmenopausal patients; the importance of insufficient endometrial sampling
Abstract
Aim: We aimed to evaluate the endometrial sampling results and to determine the frequency of non diagnostic endometrial sampling in the postmenopausal patient population.
Materials and Method: In this retrospective study, endometrial biopsy results obtained from 825 postmenopausal women who applied to Bursa City Hospital's Obstetrics and Gynecology Department between July 2019 and March 2021 were evaluated.
Results: 922 endometrial sampling results from 825 postmenopausal patients were evaluated. The mean age of the patients was 56.96±7.21 and the mean menopause time was 7.43±7.14 years. When the histopathological evaluation of the first endometrial sampling taken from the patients was performed, 25.45% of the patients had insufficient endometrial sampling, while this rate was 21.61% in the group of patients who presented with the complaint of postmenopausal bleeding. The most common endometrial pathology was endometrial polyp (22.1%), and the incidence of malignancy in our study group was 6.18%. In subgroup analyzes, the incidence of malignancy was higher (18.80%) in the age group >60 years, and it was also determined that insufficient endometrial sampling increased with age. Re-biopsy was obtained from only 20% of the patients whose first endometrial sampling result was insufficient. Endometrial cancer was detected in 3 of these patients and the presence of atypical endometrial hyperplasia in 1 patient.
Conclusion: It has been observed that in addition to the increase in the incidence of endometrial cancer with advancing age, the frequency of insufficient endometrial sampling also increases. Considering the risk factors for endometrial cancer, these patients should be encouraged to continue their follow-up.
References
- 1. Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1996;866:1-107
- 2. Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol 1995;172:1488-94
- 3. Wolfman, W. No. 249-Asymptomatic Endometrial Thickening. Journal of Obstetrics and Gynaecology Canada, 40(5), e367–e377. 2018. doi:10.1016/j.jogc.2018.03.005
- 4. Yıldız Ş, Alay İ. Risk Factors and hysteroscopic resuls for insufficient tissue from endometial biopsy. Namık Kemal Tıp Dergisi, 8 (2) , 204-211. 2020 doi: 10.37696/nkmj.667710
- 5. van Hanegem N, Prins MM, Bongers MY, Opmeer BC, Sahota DS, Mol BW, Timmermans A. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016 Feb;197:147-55. doi: 10.1016/j.ejogrb.2015.12.008
- 6. Aue-Aungkul A, Kleebkaow P, Kietpeerakool C. Incidence and risk factors for insufficient endometrial tissue from endometrial sampling. Int J Womens Health. 2018 Aug 15;10:453-457. doi: 10.2147/IJWH.S172696
- 7. Ewies AA, Shaaban KA, Merard R, Zanetto U. Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant. J Clin Pathol. 2014 Aug;67(8):673-7. doi: 10.1136/jclinpath-2014-202210
- 8. Ateş S, Gökmen Karasu AF, Çalı H, Soyman Z, Uysal Ö. Factors Associated with Insufficient Endometrial Sampling in Postmenopausal Women. Med Bull Haseki 2020;58:65-71
- 9. van Doorn HC, Opmeer BC, Burger CW, Duk MJ, Kooi GS, Mol BW; Dutch Study in Postmenopausal Bleeding (DUPOMEB). Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results. Int J Gynaecol Obstet. 2007 Nov;99(2):100-4. doi:10.1016/j.ijgo.2007.05.040
- 10. WHO Classification of Tumours Editorial Board. Female Genital Tumours WHO Classification of Tumours Series Vol 4, 5th ed;2020
- 11. ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018 May;131(5):e124-e129. doi: 10.1097/AOG.0000000000002631
- 12. Goldstein RB, Bree RL, Benson CB, Benacerraf BR, Bloss JD, Carlos R, et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. J Ultrasound Med 2001;20: 1025–36
- 13. Pekin T, Yörük P, Durmuşoğlu F. Anormal uterin kanaması olan postmenopozal kadınlara yaklaşım ve endometriumun değerlendirilmesinde kullanılan tanı yöntemlerinin sistematik gözden geçirilmesi. Turkiye Klinikleri J Gynecol Obst 2007;17:44-53
- 14. Milojkovic M, Hrgovic Z, Maass N, Jonat W, Hrgovic I, Buković D et al. Assessment of reliability endometrial brush cytology in detection etiology of late postmenopausal bleedings. Arch Gynecol Obstet. 2004 May;269(4):259-62. doi:10.1007/s00404-002-0414-4. Epub 2002 Oct 29. Erratum in: Arch Gynecol Obstet. 2005 Jan;271(1):94
- 15. Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol. 2003 Feb;188(2):401-8. doi: 10.1067/mob.2003.154
- 16. Khalid AS, Burke C. A randomised trial of Medgyn Endosampler® vs Endocurette® in an outpatient hysteroscopy clinic setting. Gynecol Surg 11, 179–184 (2014). doi.org/10.1007/s10397-014-0848-2
- 17. Soeters R, Whittaker J, Dehaeck K. Endometrial sampling: a comparison between the Pipelle® endometrial sampler and the Endosampler®, Southern African Journal of Gynaecological Oncology,2011; 3:1, 34-38, doi: 10.1080/20742835.2011.11441172
- 18. Tumrongkunagon S, Suknikhom W. Histological Sampling of Endometrial Tissue: Comparison between the MedGyn® Endosampler and Formal Fractional Curettage in Patients with Abnormal Uterine Bleeding. Asian Pac J Cancer Prev. 2019;20(11):3527-3531. Published 2019 Nov 1. doi:10.31557/APJCP.2019.20.11.3527
- 19. Xie B, Qian C, Yang B, Ning C, Yao X, Du Y et al. Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy (Pipelle) and Diagnostic Dilation and Curettage. J Minim Invasive Gynecol. 2018 May-Jun;25(4):724-729. doi: 10.1016/j.jmig.2017.11.018
- 20. Selvaggi L, Cormio G, Ceci O, Loverro G, Cazzolla A, Bettochi S. Hysteroscopy does not increase the risk of microscopic extrauterine spread in endometrial carcinoma. Int J Gynecol Cancer 2003;13:223-7
- 21. Munro MG; Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J. 2014 Winter;18(1):55-70. doi: 10.7812/TPP/13-072
- 22. Schmidt T, Breidenbach M, Nawroth F, Mallmann P, Beyer I M, Fleisch M C et al. Hysteroscopy for asymptomatic postmenopausal women with sonographically thickened endometrium. Maturitas;2009, 62(2), 176–178. doi:10.1016/j.maturitas.2008.11.018
- 23. Korkmazer E, Solak N, Üstünyurt E. Hysteroscopic assessment of postmenopausal endometrial thickening. Prz Menopauzalny. 2014 Dec;13(6):330-3. doi: 10.5114/pm.2014.47985
- 24. Ozelci R, Dilbaz B, Akpınar F, Kınay T, Baser E, Aldemir O et al. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci. 2019 Jul;62(4):273-279. doi: 10.5468/ogs.2019.62.4.273
- 25. Trojano G, Damiani GR, Casavola VC, Loiacono R, Malvasi A, Pellegrino A et al. The Role of Hysteroscopy in Evaluating Postmenopausal Asymptomatic Women with Thickened Endometrium. Gynecol Minim Invasive Ther. 2018 Jan-Mar;7(1):6-9. doi: 10.4103/GMIT.GMIT_10_17
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 30, 2022 |
| Submission Date | September 24, 2021 |
| Acceptance Date | December 20, 2021 |
| Published in Issue | Year 2022 Volume: 19 Issue: 3 |
