Efficacy of diagnostic hysteroscopy in postmenopausal women
DOI:
https://doi.org/10.33448/rsd-v11i1.25454Keywords:
Ultrasonography; Hysteroscopy; Menopause.Abstract
Diagnostic hysteroscopy is the gold standard method in endometrial evaluation, allowing direct visualization of the entire uterine cavity, besides the identification of pathologies and biopsy of suspicious lesions. To evaluate the efficacy of diagnostic hysteroscopy in postmenopausal women. An analytical cross-sectional study, developed in a university hospital. The sample consisted of 188 patients who underwent diagnostic hysteroscopy from September 2014 to September 2017. Hysteroscopy was compared with ultrasonography and anatomopathological results. Univariate and bivariate statistics were calculated. The mean age of the patients was 59.6±7.7 years and the mean time of menopause was 11.2±8 years. Hysteroscopy showed a higher sensitivity for detection of endometrial polyp (91.8%) and greater specificity in the exclusion of hyperplasia (61.4%). The main indication of the examination was endometrial thickening (72.3%) and the main finding was polypoid formation (45.7%). For asymptomatic patients, ultrasonography showed 100% and 100% of sensitivity and 10.6% and 36.2% of specificity using 5 to 9 mm as cutoff, respectively, for the diagnosis of atypical hyperplasia/endometrial cancer. Patients with atypical hyperplasia or cancer had a greater thickness (p=0.012). There was no correlation between bleeding time and endometrial cancer. Hysteroscopy was effective in the diagnosis of endometrial polyps. The main indication of the examination was endometrial thickening and the main hysteroscopic finding was endometrial polyp. Greater limit of endometrial echo thickness can be proposed in asymptomatic postmenopausal women for the indication of hysteroscopy.
References
ACOG (American College of Obstetricians and Gynecologists). (2009). ACOG Committee Opinion No. 440: The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstetrics & Gynecology, 114, 409–411.
Accorsi Neto, A., Gonçalves, W., Mancini, S., Soares Junior, J., Haidar, M., Lima, G., et al. (2003). Comparação entre a histerossonografia, a histeroscopia e a histopatologia na avaliação da cavidade uterina de mulheres na pós-menopausa. Revista Brasileira de Ginecologia e Obstetrícia, 25, 667-72.
American Cancer Society (2017). Cancer Facts & Figures. Atlanta: American Cancer Society, p. 29.
Baracat, E. C., Soares Júnior, J. M., Haidar, M. A., & de Lima, G. R. (2003). Aspectos reprodutivos no climatério. In C .E. Fernandes (Eds.), Menopausa: diagnóstico e tratamento (1st ed., p.125-129). Segmento.
Berek, J. S. (2014). Tratado de Ginecologia (15th ed). Guanabara Koogan.
Borges P. (2019). Correlação ultrassonográfica e histeroscópica no diagnóstico de pólipos endometriais em mulheres na pós-menopausa [Tese, Faculdade de Medicina de Botucatu].
Branco, H. K. M. S. M. C., Depes, D. B., Baracat, F. F., Lippi, U. G., Takahashi, W. H., & Lopes, R. G. C. (2008). Achados histeroscópicos em pacientes na pós-menopausa com espessamento endometrial à ultra-sonografia. Einstein, 6 (3), 287-292.
Breijer, M., Peeters, J., Opmeer, B., Clark, T., Verheijen, R., Mol, B., et al. (2012). Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 40 (6), 621-629.
Burbos, N., Musonda, P., Giarenis, I., Shiner, A., Giamougiannis, P., Morris, E., et al. (2010). Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: the Norwich DEFAB risk assessment tool. British Journal of Cancer. 102 (8), 1201-1206.
Campaner, A., Piato, S., Ribeiro, P., Aoki, T., Nadais, R., & Prado, R. (2004). Achados histeroscópicos em mulheres na pós-menopausa com diagnóstico de espessamento endometrial por ultra-sonografia transvaginal. Revista Brasileira de Ginecologia e Obstetrícia, 26 (1), 53-58.
Costa, H. L. F. F., & Costa, L. O. B. F. (2008). Histeroscopia na menopausa: análise das técnicas e acurácia do método. Revista Brasileira de Ginecologia e Obstetrícia, 30 (10), 524-530.
Donadio, N., Albuquerque, Neto, L. (2001). Consenso brasileiro em videoendoscopia ginecológica. São Paulo: FEBRASGO.
Elfayomy, A., Habib, F., & Alkabalawy, M. (2012). Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium. Archives of Gynecology and Obstetrics. 285 (3), 839- 843.
Gambacciani, M., Monteleone, P., Ciaponi, M., Sacco, A., & Genazzani, A. (2004). Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women. Maturitas, 48 (4), 421-424.
INCA (Instituto Nacional de Câncer José Alencar Gomes da Silva). (2015). Estimativa 2016: incidência de câncer no Brasil. INCA, p. 49-50.
Labastida, R. N. (1990). Tratato y atlas de histeroscopia (1st ed). Salvat.
Lo, K., & Yuen, P. (2000). The Role of Outpatient Diagnostic Hysteroscopy in Identifying Anatomic Pathology and Histopathology in the Endometrial Cavity. The Journal of the American Association of Gynecologic Laparoscopists, 7(3), 381-385.
Machado, M., Pina, H., & Matos, E. (2003). Acurácia da histeroscopia na avaliação da cavidade uterina em pacientes com sangramento uterino pós-menopausa. Revista Brasileira de Ginecologia e Obstetrícia. 25 (4), 237-241.
Metello, J., Relva, A., Milheras, E., & Colaço, J. (2008). Eficácia diagnóstica da histeroscopia nas metrorragias pós-menopausa. Acta Médica Portuguesa, 21 (5), 483-488.
Pop-Trajkovic-Dinic, S., Ljubic, A., Kopitovic, V., Antic, V., Stamenovic, S., & Trninic-Pjevic, A. (2013). The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding. Vojnosanitetski pregled. 70 (8), 747-750.
Sarvi, F., Alleyassin, A., Aghahosseini, M., Ghasemi, M., & Gity, S. (2016). Hysteroscopy: A necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness. Journal of Turkish Society of Obstetric and Gynecology, 13 (4), 183-188.
Silva D. (2015). Comparação entre os achados ecográficos, histeroscópicos e o anatomopatológico de pacientes pós menopausa encaminhadas para o ambulatório de histeroscopia [Tese, Universidade Federal de Ciências da Saúde de Porto Alegre].
Smith-Bindman, R., Weiss, E., & Feldstein, V. (2004). How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound in Obstetrics and Gynecology. 24 (5),558-565.
Takacs, P., De Santis, T., Nicholas, M., Verma, U., Strassberg, R., Duthely, L. (2005). Echogenic Endometrial Fluid Collection in Postmenopausal Women Is a Significant Risk Factor for Disease. Journal of Ultrasound in Medicine, 24 (11), 1477-1481.
Tinelli, R., Tinelli, F. G., Cicinelli, E., Malvasi, A., & Tinelli, A. (2008). The role of histeroscopy with eye-directed biopsy in postmenopausal women with uterine bleeding and endometrial atrophy. Menopause, 15 (4), 737-42.
Topçu, H., Taşdemir, Ü., İslimye, M., Bayramoğlu, H., & Yılmaz N. (2015). The clinical significance of endometrial fluid collection in asymptomatic postmenopausal women. Climacteric. 18 (5), 733-736.
World Health Organization. (2017). World Health Organization Statistics Information System. WHO.
Worley, M., Dean, K., Lin, S., Caputo, T., & Post, R. (2011). The significance of a thickened endometrial echo in asymptomatic postmenopausal patients. Maturitas, 68 (2), 179-181.
Yela, D. A., Ravacci, S. H., Monteiro, I. M. U., Pereira, K. C. H. M., & Gabiatti, J. R. E. (2009). Comparação do ultrassom transvaginal e da histeroscopia ambulatorial no diagnóstico das doenças endometriais em mulheres menopausadas. Revista da Associação Médica Brasileira, 55 (5), 553-556.
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