The Importace of Sonography and Hysteroscopy at Suspected Findings on Endometrium of Menopausal Women

Czech version

Authors: Milan Kudela; R. Pilka; P. Hejtmánek; P. Dzvinčuk; D. Ondrová
Authors‘ workplace: Gynekologicko-porodnická klinika LF UP a FN Olomouc, přednosta prof. MUDr. M. Kudela, CSc.
Published in: Ceska Gynekol 2008; 73(2): 104-108

Overview

Objective:
To evaluate the reliability of vaginal sonography and hysteroscopy based on the histopathologic finding in menopausal women. To compare the findings in a group of asymptomatic women with the findings in patients with a clinical symptomatology of endometrial disease.

Design:
A retrospective study.

Setting:
Department of Obstetrics and Gynecology, University Hospital, Olomouc.

Methods:
Diagnostic hysteroscopy with targeted biopsy was performed in 186 menopausal women who were referred to our department either on the basis of clinical symptoms or only on the basis of a suspected ultrasound finding. The ultrasound and hysteroscopic findings were compared with the final histopathologic diagnosis and their reliability was evaluated. The findings were evaluated separately for asymptomatic and symptomatic patients.

Results:
In all asymptomatic and in 88% symptomatic patients vaginal sonography showed endometrial thickness higher than 5 mm. In 10 patients (14%) sonographic finding suggested possibility of a malignant process. The most frequent finding at hysteroscopy was endometrial polyp, which was found in more than a half of asymptomatic women. In two patients (5%) hysteroscopic findings were suspected for malignancy. Histopathologic examination confirmed malignant tumour in 6 patients (7%). Accordance with the histopathologic finding was more often seen in hysteroscopy than in vaginal sonography.

Conclusion:
The main advantage of vaginal sonography in menopausal women is a relatively easy detection of suspicious findings on the endometrium, especially in asymptomatic patients. Hysteroscopy, on the contrary, enables to visualize the endometrial cavity and mainly the targeted biopsy. Even if the number of malignant endometrial diseases is not high (6% in asymptomatic patients) the combination of vaginal sonography and hysteroscopy is optimal for the detection of pathological findings on the endometrium.

Key words:
ultrasonography, hysteroscopy, menopause, suspect endometrial findings

Sources

1. Gerber, B., Krause, A., Muller, H. Ultrasonographic detection of asymptomatic endometrial cancer in postmenopausal patients offers no prognostic advantage over symptomatic disease discovered by uterine bleeding. Eur J Cancer, 2001, 37, p. 64-69.

2. Hrachovec, P., Pilka, R., Dzvinčuk, P., et. al. Rizikové a protektivní faktory karcinomu endometria. Gynekolog, 2001, 10, 3, s. 120-122.

3. Kudela, M. Využití hysteroskopie jako prognostického faktoru při strategii léčby endometriálního karcinomu. Gynekolog, 2001, 10, 5, s. 192-193.

4. Kudela, M., Dzvinčuk, P., Ondrová, D., et al. Zlepšuje záchyt onemocnění v symptomatickém období prognózu pacientek s karcinomem endometria? Čes Gynek, 2007, 72, 1, s. 23-26.

5. Marchetti, M., Vasile, C., Chiarelli, S. Endometrial cancer: asymptomatic endometrial findings. Characteristics of postmenopausal endometrial cancer. Eur J Gynaec Oncol, 2005, 5, p. 479-483.

6. Muensted, K., Grant, P., Woenckhaus, J., et al. Cancer of the endometrium: current aspects of diagnosis and treatment. World J Surg Oncol, 2004, 2, p. 24-27.

7. Pilka, R., Kudela, M., Dzvinčuk, P. Předoperační ultrazvukové zhodnocení myometriální invaze u pacientky s karcinomem endometria. Čes Gynek, 2001, 66, 5, s. 355-358.

8. Robertson, G. Screening for endometrial cancer. Am Med J, 2003, 178, p. 657-659.

9. World Cancer Research Fund. American Institute for Cancer Research: Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC, 1997.