Indicaciones y resultados de la histeroscopia diagnó stica / Indications and results of disgnostic histeroscopy

Introducción: Las técnicas endoscópicas han invadido la mayor parte de las especialidades médicas, demostrando sus grandes ventajas. Permite la evaluación de la cavidad uterina y del endocervix, facilitando no sólo el diagnóstico de patologías endometriales por visualización directa sino también, su tratamiento. Objetivos: Analizar y comparar las indicaciones y resultados de las histeroscopias diagnósticas en 283 pacientes de nuestro hospital, el diagnóstico ecográfico con los hallazgos histeroscópicos y los resultados patológicos en pacientes sometidas a histeroscopía por sospecha de patología endometrial. Material y Método: Es un estudio retrospectivo efectuado en 283 (N) pacientes pre y postmenopáusicas, sintomáticas o asintomáticas, previo a un estudio ecográfico transvaginal patológico o no patológico, obteniéndose una biopsia directa para el posterior estudio anatomopatológico- Comprende un tiempo desde octubre de 2006 hasta abril de 2014 en el Hospital Aeronáutico Central, con una edad promedio entre los 50 a 60 años. Resultados: Se diagnosticaron 16 canceres de endometrio, de los cuales 15 fueron Adenocarcinomas y 1 Tumor Mesodérmico Mixto: Carcinosarcoma. Como hallazgos histeroscopicos se encontraron 114 pólipos, de los cuales estudio ecográfico previo informó Pólipos (62 casos), Endometrio engrosado (46 casos), Ecografía Normal (5) y Mioma Submucoso (1). Dentro de los informes Anatomo Patológicos se hallaron 16 casos de Hiperplasia Simple sin atipía y 1 Hiperplasia Simple con atipía, 12 casos de Hiperplasia Compleja sin Atipía y 2 de Hiperplasia Compleja con atipia, asociados estos últimos con Adenocarcinoma. Conclusión: La histeroscopía constituye el método más útil para la detección de patología endometrial y para el diagnóstico de cáncer endometrial, ya que permite realizar una biopsia dirigida inmediata y en forma ambulatoria. Es indiscutible el valor diagnóstico de la histeroscopia en el sangrado uterino de la paciente posmenopáusica, por la posibilidad de diagnosticar de forma directa la presencia o no de neoplasias endometriales. La histeroscopia junto a la biopsia alcanzan una sensibilidad del 100%. La histeroscopia diagnóstica es un procedimiento seguro y bien tolerado por las pacientes. Por lo tanto en nuestra experiencia encontramos una buena correlación entre la histeroscopía y el estudio histopatológico, principalmente en el caso de lesiones focales del endometrio. Esta correlación fue menor cuando se comparó la ecografía con el estudio histopatológico

Introduction: Endoscopic techniques have invaded most medical specialties, demonstrating their great advantages. It allows evaluation of the uterine cavity and endocervix, facilitating not only the diagnosis of endometrial pathologies by direct visualization but also, its treatment. Objectives: To analyze and compare the indications and results of the diagnostic hysteroscopies in 283 patients of our hospital, the ultrasound diagnosis with the hysteroscopic findings and the pathological results in patients submitted to hysteroscopy for suspicion of endometrial pathology. Material and Method: It is a retrospective study performed in 283 (N) pre and postmenopausal patients, symptomatic or asymptomatic, prior to a pathological or non-pathological transvaginal ultrasound study, obtaining a direct biopsy for the subsequent anatomopathological study. It comprises a time from October 2006 to April 2014 in the Central Aeronautical Hospital, with an average age between 50 and 60 years. Results: 16 endometrial cancers were diagnosed, of which 15 were Adenocarcinomas and 1 Mixed Mesodermal Tumor: Carcinosarcoma. As hysteroscopic findings, 114 polyps were found, of which a previous ultrasound study reported polyps (62 cases), thickened endometrium (46 cases), normal ultrasound (5), and submucous myoma (1) Within the Anatomo Pathological reports, 16 cases of Simple Hyperplasia without atypia and 1 Simple Hyperplasia with atypia, 12 cases of Complex Hyperplasia without Atypia and 2 of Complex Hyperplasia with atypia, associated with Adenocarcinoma, were found. Conclusions: Hysteroscopy is the most useful method for the detection of endometrial pathology and for the diagnosis of endometrial cancer, since it allows an immediate directed biopsy and on an outpatient basis. The diagnostic value of hysteroscopy in the uterine bleeding of the postmenopausal patient is indisputable, given the possibility of directly diagnosing the presence or absence of endometrial neoplasms. The hysteroscopy next to the biopsy reaches a sensitivity of 100%. Diagnostic hysteroscopy is a safe procedure and well tolerated by patients. Therefore, in our experience, we found a good correlation between hysteroscopy and histopathological study, mainly in the case of focal lesions of the endometrium. This correlation was lower when the histopathological study

Evaluation of endometrial thickness by transvaginal ultrasonography in women with postmenopausal bleeding

To determine the diagnostic value of transvaginal ultrasonography in the detection of endometrial abnormalities in women with postmenopausal bleeding. Study 150 women with postmenopausal bleeding were clinically evaluated by transvaginal ultrasonography and curettage. The endometrial thickness as measured by transvaginal ultrasonography was compared with the histopathological diagnosis of the curettage specimens. El-Minia University Hospital. Women receiving hormone replacement therapy [n= 30] with a normal endometrium had a mean endometrial thickness of 5.22 +/- 3.74 mm [n=16] and women receiving hormone replacement therapy with an abnormal endometrium had an endometrial thickness of 11.2 +/- 6.6mm [n=14]. The corresponding figures for women who did not use hormone replacement therapy [n=120] were 4.44 +/- 2.16 mm [n=63] and 14.63 +/- 8.9 mm [n=57] respectively. The mean endometrial thickness of atrophic endometrium, hyperplasia, polyp, cancer and proliferative / secretory endometrium were each 3.09 +/- 1.67 mm, 11.76 +/- 6.98 mm, 10.87 +/- 4.71 mm, 21.95 +/- 8.09 mm and 4.52 +/- 1.88 mm respectively. At a cutoff limit of 5mm for endometrial thickness, the sensitivity of transvaginal ultrasonography for detecting a histologically abnormal endometrium was 91.5%, the specificity 86%, the positive predictive value 85.5% and the negative predictive value 91.8%. Transvaginal ultrasonography with measurement of endometrial thickness is a safer and a non invasive outpatient procedure which has the advantage of not only predicting endometrial abnormality but also and perhaps more importantly, excluding pelvic pathology