ultrazvuk endometrija u postmenopauzi
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Ultrazvuk endometrija u postmenopauzi. Boris Ujević. Postmenopauza. Žene koje krvare Asimptomatske Ultrazvučni pregled vaginalnom sondom. Žene u postmenopauzi s krvarenjem. Tanki endometrij - praćenje Zadebljani endometrij – dijagnoza Što je “tanki”, a što “debeli” endometrij?. - PowerPoint PPT PresentationTRANSCRIPT
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Ultrazvuk endometrija u Ultrazvuk endometrija u postmenopauzipostmenopauzi
Boris UjevićBoris Ujević
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PostmenopauzaPostmenopauza
►Žene koje krvareŽene koje krvare►Asimptomatske Asimptomatske ►Ultrazvučni pregled vaginalnom Ultrazvučni pregled vaginalnom
sondomsondom
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Žene u postmenopauzi s Žene u postmenopauzi s krvarenjemkrvarenjem
►Tanki endometrij - praćenjeTanki endometrij - praćenje►Zadebljani endometrij – dijagnozaZadebljani endometrij – dijagnoza►Što je “tanki”, a što “debeli” Što je “tanki”, a što “debeli”
endometrij?endometrij?
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Žene u postmenopauzi s Žene u postmenopauzi s krvarenjemkrvarenjem
►mjeri se “double layer” mjeri se “double layer” ►gotovo da nema rada koji opisuje gotovo da nema rada koji opisuje
Ca-endometrija ispod 4mmCa-endometrija ispod 4mm►gotovo 100% negativna prediktivna gotovo 100% negativna prediktivna
vrijednost vrijednost
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Žene u postmenopauzi s Žene u postmenopauzi s krvarenjemkrvarenjem
►““4mm or less has a risk of malignancy of 4mm or less has a risk of malignancy of one in 917, and therefore endometrial one in 917, and therefore endometrial biopsy is not required”biopsy is not required”
ACOG Committee Opinion No. 426. ACOG Committee Opinion No. 426.
The role of transvaginal ultrasonography inThe role of transvaginal ultrasonography in
the evaluation of postmenopausal bleeding.the evaluation of postmenopausal bleeding.
American College of Obstetricians and American College of Obstetricians and Gynecologists.Gynecologists.
Obstet Gynecol 2009;113:462-4.Obstet Gynecol 2009;113:462-4.
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►Zadebljani endometrij >4mmZadebljani endometrij >4mm80% patologija 80% patologija >90% fokalne promjene >90% fokalne promjene
(60% polipi)(60% polipi)
Žene u postmenopauzi s Žene u postmenopauzi s krvarenjemkrvarenjem
Litta P, et al. Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas. 2005;50:117-23.Epstein E, et al. Dilatation and curettage fail to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 2001;80:1131-6.
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PostmenopauzaPostmenopauza
►Asimptomatske ženeAsimptomatske žene►Zadebljani endometrij !?!Zadebljani endometrij !?!►Hyperplasio endometriiHyperplasio endometrii►D&CD&C
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SIS SIS
►SIS (saline infusion sonography)SIS (saline infusion sonography)►Office histeroscopy Office histeroscopy
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HysterosonographyHysterosonography
►SonohysterographySonohysterography►Saline Infusion Sonography (SIS)Saline Infusion Sonography (SIS)
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SISSIS
►kavum koji je virtualna šupljina postaje kavum koji je virtualna šupljina postaje prava šupljina i može se pregledati u prava šupljina i može se pregledati u cijelosticijelosti
► jednostavno, bezbolno i jeftino jednostavno, bezbolno i jeftino obogaćenje ultrazvukaobogaćenje ultrazvuka
►podudarnost histerosonografije i podudarnost histerosonografije i histeroskopije oko 95%histeroskopije oko 95%
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SISSIS
►tvrdi katetertvrdi kateter►Foley – balon ometa vizualizacijuFoley – balon ometa vizualizaciju►zrak u kateteru radi artefaktezrak u kateteru radi artefakte►stenoza cerviksastenoza cerviksa
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Endometralni polipiEndometralni polipi
►spoznaje o uzrocima, ponašanju i spoznaje o uzrocima, ponašanju i incidenciji nepotpuneincidenciji nepotpune
►točna prevalencija nepoznatatočna prevalencija nepoznata►do 25% žena u generativnoj dobido 25% žena u generativnoj dobi►do 10% žena u postmenopauzido 10% žena u postmenopauzi
Ben-Arie A, et al. The Malignant potential of enodmetrial polyps. Eur J Obs Gyn Rep Biol 2004;115:206-10.
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Ca u endometralnom polipuCa u endometralnom polipu
►premenopauza premenopauza 1,7%1,7%►postmenopauzapostmenopauza 5,42%5,42%►postmenopauza asimptomatskapostmenopauza asimptomatska
1,51%1,51%►postmenopauza simptomatskapostmenopauza simptomatska 4,47%4,47%►veličina (ni)je povezna s malignitetomveličina (ni)je povezna s malignitetom
Lee SC, et al. The oncogenic potential of endometrial polyps: a systematic
review and meta-analysis. Obstet Gynecol. 2010;116:1197-205.
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D D & & CC►slijep postupakslijep postupak►uzorak pokriva oko 50% kavumauzorak pokriva oko 50% kavuma►D D && C neće odstraniti fokalnu leziju u C neće odstraniti fokalnu leziju u
cijelosti u oko 80% slučajeva (a fokalne cijelosti u oko 80% slučajeva (a fokalne su 90%)su 90%)
►““promaši” oko 50% polipapromaši” oko 50% polipa►opća anestezija???opća anestezija???
Epstein E, et al. Dilatation and curettage fail to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 2001;80:1131-6.
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HisteroskopijaHisteroskopija
►histeroskopija sa polipektomijom ili histeroskopija sa polipektomijom ili uzimanjem uzorka s fokalnog uzimanjem uzorka s fokalnog zadebljanjazadebljanja
►histeroskopska ablacija polipa je histeroskopska ablacija polipa je optimalna terapijaoptimalna terapija
►pouzdano odstranjuje polip u bazalnoj pouzdano odstranjuje polip u bazalnoj zoni zoni
►sprečava ponovno javljanjesprečava ponovno javljanje
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HisteroskopijaHisteroskopija
►histeroskopija invazivan zahvat kao i histeroskopija invazivan zahvat kao i D&C, manje komplikacijaD&C, manje komplikacija
►polipektomija kod žena u polipektomija kod žena u postmenopauzi je zahvat malog rizika postmenopauzi je zahvat malog rizika
►dijagnostički i terapeutski zahvatdijagnostički i terapeutski zahvat
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Zadebljani endometrij u Zadebljani endometrij u postmenopauzipostmenopauzi
►Zadebljani endometrij u Zadebljani endometrij u postmenopauzi je gotovo uvijek postmenopauzi je gotovo uvijek fokalna promjenafokalna promjena
►D&C najčešće “promaši” fokalnu D&C najčešće “promaši” fokalnu promjenupromjenu
►Treba učiniti histeroskopiju Treba učiniti histeroskopiju
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HVALAHVALA