ABSTRACT
Abstract Objective To evaluate the accuracy of transvaginal ultrasonography, hysteroscopy and uterine curettage in the diagnosis of endometrial polyp, submucous myoma and endometrial hyperplasia, using as gold standard the histopathological analysis of biopsy samples obtained during hysteroscopy or uterine curettage. Methods Cross-sectional study performed at the Hospital Universitário de Brasília (HUB). Data were obtained from the charts of patients submitted to hysteroscopy or uterine curettage in the period from July 2007 to July 2012. Results One-hundred and ninety-one patients were evaluated, 134 of whom underwent hysteroscopy, and 57, uterine curettage. Hysteroscopy revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps, 78.1% for myoma and 63.2% for endometrial hyperplasia. Within the 57 patients submitted to uterine curettage, there was an accuracy of 56% for polyps and 54.6% for endometrial hyperplasia. Conclusion Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management.
Resumo Objetivo avaliar a acurácia da ultrassonografia transvaginal, da histeroscopia e da curetagem uterina no diagnóstico de pólipo endometrial, mioma submucoso e hiperplasia de endométrio, utilizando como padrão-ouro a análise histopatológica de amostras obtidas por biópsia realizada durante a histeroscopia ou a curetagem. Métodos estudo transversal realizado no Hospital Universitário de Brasília (HUB), cujas informações foram obtidas nos prontuários das pacientes que foram submetidas à histeroscopia ou curetagem uterina no período de julho de 2007 a julho de 2012. Resultados Foram avaliadas 191 pacientes, sendo que 134 foram submetidas à histeroscopia e 57 à curetagem uterina. Observou-se acurácia diagnóstica maior que 90% para todas as patologias avaliadas por histeroscopia, enquanto que por ultrassonografia transvaginal observou-se acurácia de 65,9% para pólipo, 78,1% para mioma e 63,2% para hiperplasia endometrial. Nas 57 pacientes submetidas a curetagem uterina, observou-se acurácia de 56% para pólipo e de 54,6% para hiperplasia endometrial. Conclusão Idealmente, após a investigação inicial com ultrassonografia transvaginal, deveria, sempre que necessário, ser realizada histeroscopia com biópsia guiada da lesão, o que melhoraria a acurácia diagnóstica e posterior conduta clínica.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Hysteroscopy , Ultrasonography/methods , Uterine Diseases/diagnostic imaging , Uterine Diseases/pathology , Cross-Sectional Studies , Curettage , Gynecologic Surgical Procedures , Polyps , Reproducibility of Results , Uterine Diseases/surgery , VaginaABSTRACT
Objetivo: presentar una técnica quirúrgica para la resección de miomas submucosos de gran tamaño por vía histeroscópica. Materiales y métodos: reportamos el caso de una paciente con dos miomas submucosos de gran tamaño, con componente intramiometrial, que fue sometida a miomectomía histeroscópica en la Clínica SOMA, centro de alta complejidad, ubicado en Medellín, Colombia. Se presenta una técnica de miomectomía por histeroscopia con el uso del resectoscopio para disminución del volumen tumoral acompañado de disección roma para crear un plano de clivaje adecuado para la enucleación y extracción completa del tumor. Conclusión: la técnica que combina el uso de la resectoscopia con la enucleación del mioma permitiría la resección de tumores de gran tamaño con menor tiempo quirúrgico, un menor gasto de glicina y, por ende, menor riesgo de intoxicación hídrica y de perforaciones.
Objective: To present a surgical technique for excising large submucosal fibroids using histeroscopy. Materials and methods: We report the case of a patient with two large submucosal fibroids with intramyometrial component, undergoing hysteroscopic myomectomy at Clínica SOMA, a high-complexity institution in Medellin, Colombia. We present a hysteroscopic myomectomy technique using the resectoscope for tumor volume reduction, and the use of a dissection technique that allows to create an adequate cleavage plane for complete tumor removal. Conclusion: A technique combining the use of resectoscopy with fibroid enucleation would allow to resect large tumors with shorter operating time, lower glycine use and, consequently, a lower risk of fluid toxicity and perforations.