Dilatasyon ? küretaj ve pipelle biyopsinin histopatolojik tanı başarısının araştırılması
Histopathologic diagnosis with dilatation ? curettage and pipelle biopsy: Comparision of material sufficiency and diagnostic accuracy
Yazar: FIRAT ÖKMEN
Danışman: DOÇ. DR. MERT KAZANDI
Ege Üniversitesi / Tıp Fakültesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Kadın Hastalıkları ve Doğum = Obstetrics and Gynecology
Dizin: Histerektomi = Hysterectomy

Özet:
Amac: Pipelle biyopsi materyal yeterliliği ve tanısal doğruluğunun, dilatasyon küretaj ve histerektomi materyalleri ile karşılaştırılması.Metod: Çalışma kapsamına herhangi bir nedenle endometrial biyopsi endikasyonu olan ve hem D&C hem de pipelle endometrial biyopsi yapılan 82 olgu ve bunlar içinden herhangi bir sebeple histerektomi endikasyonu konan ve opere edilen 66 olgu alındı. Histopatolojik bulgular normal, endometrial polip, atipisiz hiperplazi, atipili hiperplazi, atrofi ve yetersiz materyal olmak üzere altı grup halinde değerlendirildi.Bulgular: Pipelle ile D&C arasındaki histopatolojik uyuma bakıldığında (n=82); pipelle ile normal endometrium histolojisi saptanan 63 olgunun 22'sinde (%27) D&C'den farklı bir tanı elde edildi. Pipelle sonucu normal saptanan olguların 3 tanesinde D&C sonucu Atipili Hiperplazi olarak saptandı. Geriye kalan 19 olgudan; 9 olguda D&C sonucu Endometrial polip, 8 olguda Atipisiz Hiperplazi ve 2 olgu atrofi olarak belirlenmiştir. D&C sonucu atipili hiperplazi saptanan 6 olgunun 3 tanesinin pipelle ile tanınmadığı belirlendi. D&C sonucunda atipisiz endometrial hiperplazi saptanan 12 olgunun pipelle sadece 3 tanesini tanıyabilmiştir. Onüç endometrial polip olgusunun 1 tanesinin pipelle tarafından tanı konulduğu görüldü. Pipelle ile 6 (% 7) olguda, D&C ile ise 2(%3) olguda yetersiz materyal elde edilmiş olduğu saptandı.Sonuc: Pipelle ve D&C yaygın endometrial lezyonlarda hemen hemen eşit başarıya sahipken, Pipelle fokal patolojilerin tanınmasında, sınırlı bilgi sağlamaktadır.

Abstract:
Aim: To make a comparison between the material sufficiency and diagnostic accuracy of Pipelle biopsy with curettage and hysterectomy materials.Methods: 82 cases with indications for endometrial biopsy due to any reason and on which endometrial biopsy was performed both with D&C and Pipelle and from among these, 66 cases on whom indication for hysterectomy was established for any one reason and who were operated were included in the study. Histopathologic findings were examined in six groups being normal, endometrial polyp, non-atypical hyperplasia, atypical hyperplasia, atrophy, and insufficient material.Results: When the histopathological compatibility between Pipelle and D&C was considered (n=82), a result that was different from D&C was obtained in 22 (67%) of the 63 cases in whom normal endometrial histology was found with Pipelle. In 3 of the cases with normal Pipelle results, the D&C result was found to be Atypical Hyperplasia. Of the remaining 19 cases, the D&C result was found to be Endometrial polyp in 9 cases, non-atypical hyperplasia in 8 cases, and atrophy in 2 cases. It was found that 3 cases, whose D&C result was identified as Atypical Hyperplasia, were not recognized with Pipelle. Pipelle was able to identify only 3 of the cases, in whom non-atypical endometrial hyperplasia was established. It was observed that only one out of 13 cases of endometrial polyp was diagnosed with Pipelle. It was found that insufficient material was obtained in 6 (7%) of the cases with Pipelle and 3 (3%) with D&C.Conclusion: While Pipelle and D&C have a nearly equal level of success in widespread endometrial lesions, Pipelle provided limited diagnostic accuracy in recognition of focal pathologies.