Anormal uterin kanamalı hastalarda transvajinal ultrason ve histeroskopi bulgularının karşılaştırılması
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Tarih
2022
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Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Anormal uterin kanama tüm jinoloji nedenli hastane başvuruları arasında önemli bir yer tutmaktadır. Endometrial polipler ve submuköz leiomyomalar etiyolojide başlıca etkenlerden ikisidir. Tanıda kullanılan transvajinal ultrasonografi, ofis histeroskopi ve endometriyal örneklemenin etkinliklerinin karşılaştırılması, hasta değerlendirme stratejilerinin belirlenmesinde teorik alt yapı oluşturmaktadır. Çalışmamıza Eylül 2018 – Nisan 2022 Tarihleri arasında Namık Kemal Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Polikliniğine farklı sebeplerden dolayı başvuru yapan 666 hasta içinden anormal uterin kanama nedeniyle başvuran 367 sayısı kadarı dahil edildi. Bu hastalarda öncelikle transvajinal ultrasonografi ve takiben ofis histereskopi yapılması koşulu arandı. Bu hastalardan mevcut olanların endometriyal örnekleme sonuçları da toplandı. Patoloji sonuçları altın standart kabul edilerek, transvajinal ultrasonografi ve ofis histeroskopi yöntemlerinin sonuçlarıyla karşılaştırıldı. Ofis bulguları ile patoloji sonuçları arasında istatistiksel olarak anlamlı bir uyum görülmemektedir (p=0,001; p<0,05).Ofis bulgularına göre olguların %9,0'unda (n=20) myom, %36,3'ünde (n=81) polip ve %54,7'sinde (n=122) istmosel/doğal saptanırken, patoloji sonucunda göre olguların %4,9'unda (n=11) myom, %86,13'inde (n=192) polip ve %9,0'unda (n=20) istmosel/doğal saptanmıştır.Ofis bulgularına göre myom saptanan 20 olgunun, patolojide sadece 6'sında myom saptanırken, 12'sinde polip ve 2'sinde istmosel/doğal saptanmıştır. Ofis bulgularına göre polip saptanan 81 olgunun, patolojide sadece 73'ünde polip saptanırken, 2'sinde myom ve 6'sında istmosel/doğal saptanmıştır. Ofis bulgularına göre istmosel/doğal saptanan 122 olgunun, patolojide sadece 12'sinde istmosel/doğal saptanırken, 3'ünde myom ve 107'sinde polip saptanmıştır. Ofis bulguları sonucu ile patoloji sonucu myom görülme oranları arasında istatistiksel olarak anlamlı bir uyum görülmektedir (p=0,064; p>0,05); iki sonuç arasındaki uyum düzeyi 0,345 olarak saptanmıştır (Kappa uyum katsayısı: 0,345; p=0,001; p<0,05). Ofis bulgularına göre olguların %9,0'unda (n=20) myom saptanırken, patoloji sonucunda göre olguların %4,9'unda (n=11) myom saptanmıştır. Ofis bulgularına göre myom saptanan 20 olgunun, patoloji sonucuna göre sadece 6'sında myom saptanırken, 14'ünde myom saptanmamıştır. Ofis bulgularına göre myom saptanmayan 203 olgunun, patoloji sonucuna göre sadece 198'inde myom saptanmazken, 5'inde myom saptanmıştır. Buna göre testin duyarlılığı %30,00; özgüllüğü %97,54; pozitif kestirim değeri %54,55; negatif kestirim değeri %93,40 ve doğruluğu 91,48 olarak saptanmıştır. Ofis bulguları sonucu ile patoloji sonucu polip görülme oranları arasında istatistiksel olarak anlamlı bir uyum görülmemektedir (p=0,001; p<0,05); iki sonuç arasındaki uyum düzeyi 0,049 olarak saptanmıştır (Kappa uyum katsayısı: 0,049; p=0,224; p>0,05). Ofis bulgularına göre olguların %36,3'ünde (n=81) polip saptanırken, patoloji sonucunda göre olguların %86,1'inde (n=192) polip saptanmıştır. Ofis bulgularına göre polip saptanan 81 olgunun, patoloji sonucuna göre sadece 73'ünde polip saptanırken, 8'inde polip saptanmamıştır. Ofis bulgularına göre polip saptanmayan 142 olgunun, patoloji sonucuna göre sadece 23'ünde polip saptanmazken, 119'unda polip saptanmıştır. Buna göre testin duyarlılığı %90,12; özgüllüğü %16,20; pozitif kestirim değeri %38,02; negatif kestirim değeri %74,19 ve doğruluğu 43,05 olarak saptanmıştır. Sonuçlar değerlendirildiğinde yöntemlerin patoloji ile uyumlulukları literatürdeki örneklere göre daha düşük çıkmıştır. Bunda kullanılan yöntemlerin pek çok farklı kişi ve cihaz ile uygulanması, ultrasonografi cihazlarının kalitesi, bazı yassı poliplerin atlanması, 3D, doppler veya salin infüzyon sonografi yöntemlerinin uygulanmamış olması gösterilebilir. Çalışmamız sonrasında benzer koşullara sahip eğitim öğretim kliniklerinde anormal uterin kanamanın değerlendirilmesinde yöntemlere bütüncül olarak yaklaşılması gerekliliği çıkarımında bulunmaktayız.
Abnormal uterine bleeding has an important place among all gynecological hospital admissions. Endometrial polyps and submucous leiomyomas are two of the main factors in etiology. Comparison of the efficacy of transvaginal ultrasonography, office hysteroscopy and endometrial sampling used in diagnosis constitutes the theoretical basis for determining patient evaluation strategies. Among 666 patients who applied to Namık Kemal University Health Practice and Research Hospital Gynecology and Obstetrics Polyclinic for different reasons between September 2018 and April 2022, 367 patients who applied due to abnormal uterine bleeding were included in our study. In these patients, first transvaginal ultrasonography and then office hysteroscopy were required. The endometrial sampling results of the present patients were also collected. Pathology results were accepted as the gold standard and compared with the results of transvaginal ultrasonography and office hysteroscopy methods. There is no statistically significant correlation between office hysteroscopy findings and pathology results (p=0.001; p<0.05). According to office hysteroscopy findings, myoma was found in 9.0% (n=20) of the cases, and 36.3% (n=. 81) polyps and 54.7% (n=122) istmocele/natural, according to the pathology results; 4.9% (n=11) of the cases had myoma, 86.13% (n=192) had polyp and Ismocele/natural was found in 9.0% (n=20). According to office hysteroscopy findings, polyps were detected in only 73 of 81 cases in the pathology, while myoma was found in 2 and isthmocele/natural in 6 cases. According to the office hysteroscopy findings, isthmocele/natural was found in only 12 of 122 cases in pathology, while fibroids were found in 3 and polyps in 107. There is a statistically significant correlation between the results of office findings and the rate of myoma in pathology results (p=0.064; p>0.05); The level of agreement between the two results was found to be 0.345 (Kappa coefficient of agreement: 0.345; p=0.001; p<0.05). According to office hysteroscopy findings, myoma was detected in 9.0% (n=20) of the cases, while myoma was found in 4.9% (n=11) of the cases according to the pathology results. While myoma was detected in only 6 of the 20 cases with fibroids according to the office hysteroscopy findings, according to the pathology results, no myoma was found in 14. While myoma was not detected in only 198 of the 203 cases in which myoma was not detected according to the office hysteroscopy findings, according to the pathology results, myoma was found in 5 of them. Accordingly, the sensitivity of the test is 30.00%; specificity 97.54%; positive predictive value of 54.55%; negative predictive value was determined as 93.40% and accuracy as 91.48%. There is no statistically significant correlation between the results of office findings and the incidence of polyps in pathology results (p=0.001; p<0.05); The level of agreement between the two results was determined as 0.049 (Kappa coefficient of agreement: 0.049; p=0.224; p>0.05). While polyps were detected in 36.3% (n=81) of the cases according to office hysteroscopy findings, polyps were detected in 86.1% (n=192) of the cases according to the pathology results. According to the office hysteroscopy findings, polyps were detected in only 73 of 81 cases, according to the pathology results, and no polyps were detected in 8 of them. According to the pathology results, only 23 of the 142 cases who did not detect polyps according to office hysteroscopy findings did not have polyps, while polyps were found in 119. Accordingly, the sensitivity of the test was 90.12%; specificity 16.20%; positive predictive value of 38.02%; negative predictive value was 74.19% and accuracy was 43.05. When the results were evaluated, the compatibility of the methods with pathology was lower than the examples in the literature. The application of the methods used in this with many different people and devices, the quality of ultrasonography devices, the omission of some flat polyps, the lack of 3D, doppler or saline infusion sonography methods can be shown. After our study, we conclude that a holistic approach to methods in the evaluation of abnormal uterine bleeding is required in education and training clinics with similar conditions.
Abnormal uterine bleeding has an important place among all gynecological hospital admissions. Endometrial polyps and submucous leiomyomas are two of the main factors in etiology. Comparison of the efficacy of transvaginal ultrasonography, office hysteroscopy and endometrial sampling used in diagnosis constitutes the theoretical basis for determining patient evaluation strategies. Among 666 patients who applied to Namık Kemal University Health Practice and Research Hospital Gynecology and Obstetrics Polyclinic for different reasons between September 2018 and April 2022, 367 patients who applied due to abnormal uterine bleeding were included in our study. In these patients, first transvaginal ultrasonography and then office hysteroscopy were required. The endometrial sampling results of the present patients were also collected. Pathology results were accepted as the gold standard and compared with the results of transvaginal ultrasonography and office hysteroscopy methods. There is no statistically significant correlation between office hysteroscopy findings and pathology results (p=0.001; p<0.05). According to office hysteroscopy findings, myoma was found in 9.0% (n=20) of the cases, and 36.3% (n=. 81) polyps and 54.7% (n=122) istmocele/natural, according to the pathology results; 4.9% (n=11) of the cases had myoma, 86.13% (n=192) had polyp and Ismocele/natural was found in 9.0% (n=20). According to office hysteroscopy findings, polyps were detected in only 73 of 81 cases in the pathology, while myoma was found in 2 and isthmocele/natural in 6 cases. According to the office hysteroscopy findings, isthmocele/natural was found in only 12 of 122 cases in pathology, while fibroids were found in 3 and polyps in 107. There is a statistically significant correlation between the results of office findings and the rate of myoma in pathology results (p=0.064; p>0.05); The level of agreement between the two results was found to be 0.345 (Kappa coefficient of agreement: 0.345; p=0.001; p<0.05). According to office hysteroscopy findings, myoma was detected in 9.0% (n=20) of the cases, while myoma was found in 4.9% (n=11) of the cases according to the pathology results. While myoma was detected in only 6 of the 20 cases with fibroids according to the office hysteroscopy findings, according to the pathology results, no myoma was found in 14. While myoma was not detected in only 198 of the 203 cases in which myoma was not detected according to the office hysteroscopy findings, according to the pathology results, myoma was found in 5 of them. Accordingly, the sensitivity of the test is 30.00%; specificity 97.54%; positive predictive value of 54.55%; negative predictive value was determined as 93.40% and accuracy as 91.48%. There is no statistically significant correlation between the results of office findings and the incidence of polyps in pathology results (p=0.001; p<0.05); The level of agreement between the two results was determined as 0.049 (Kappa coefficient of agreement: 0.049; p=0.224; p>0.05). While polyps were detected in 36.3% (n=81) of the cases according to office hysteroscopy findings, polyps were detected in 86.1% (n=192) of the cases according to the pathology results. According to the office hysteroscopy findings, polyps were detected in only 73 of 81 cases, according to the pathology results, and no polyps were detected in 8 of them. According to the pathology results, only 23 of the 142 cases who did not detect polyps according to office hysteroscopy findings did not have polyps, while polyps were found in 119. Accordingly, the sensitivity of the test was 90.12%; specificity 16.20%; positive predictive value of 38.02%; negative predictive value was 74.19% and accuracy was 43.05. When the results were evaluated, the compatibility of the methods with pathology was lower than the examples in the literature. The application of the methods used in this with many different people and devices, the quality of ultrasonography devices, the omission of some flat polyps, the lack of 3D, doppler or saline infusion sonography methods can be shown. After our study, we conclude that a holistic approach to methods in the evaluation of abnormal uterine bleeding is required in education and training clinics with similar conditions.
Açıklama
Anahtar Kelimeler
Anormal Uterin Kanama, Histeroskopi, Transvajinal Ultrasonografi, Abnornal Uterine Bleeding, Hysteroscopy, Transvaginal Ultrasonography, Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
