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Hysteroscopy and pelvic ultrasound in women with abnormal uterine bleeding
Selected Scientific Abstracts
Laparoscopic Management of Adnexal Postmenopausal Masses P Colombo, F Giambelli, I Sambruni, M Candiani, S De Marinis, M Busacca. 2nd Department of Obstetrics and Gynecology, "L. Mangiagalli," University of Milan, Milan, Italy.
Laparoscopic treatment of ovarian masses remains controversial. We strongly suggest that laparoscopic diagnosis of adnexal postmenopausal cysts can be safe, reliable, and successful. Until a few years ago, radical treatment by laparotomy was recommended for palpable ovaries in postmenopausal women because of the high risk of malignancy. We think that accurate preoperative screening together with strict intraoperative criteria can discriminate benign from malignant adnexal masses. Many sophisticated technologies are available to evaluate ovarian pathology, such as laboratory tests, ultrasound, color Doppler, computerized tomography, and magnetic resonance imaging. They allow more accuracy in patient selection for laparoscopy, which remains the major tool in the diagnosis of adnexal masses. Between June 1993 and October 1994 we treated 18 postmenopausal women with adnexal cysts by laparoscopy. Patients were selected following strict criteria of evaluation to exclude malignancies. The first step was careful history and physical examination, ultrasound evaluation with vaginal probe, and serum CA125 measurement. The second step was laparoscopic diagnosis with cytologic examination of the peritoneal fluid and accurate inspection of the entire abdominal cavity. We always performed bilateral adnexectomy with intraoperative frozen sections; in case of malignancy we performed an immediate laparotomy. The adnexae were extracted by abdominal endopatch to avoid spillage and dissemination. In our series no adnexal cancer was misdiagnosed, and laparoscopic treatment was performed only for benign masses.
uterine bleeding and 28 (75.7%) were asymptomatic. Hysteroscopy detected endometrial pathology (polyps, endometrial hyperplasia, neoplasm) in 21 patients (56.8%). The prevalence of the pathology was 66.7% in symptomatic patients (6/9) and 53.6% in asymptomatic ones. We found an endometrial neoplasm in 3 (8.6%) of 35 symptomatic postmenopausal women. In the same period we evaluated 3064 premenopausal and 1428 postmenopausal women by office hysteroscopy. The prevalence of endometrial pathology was 36.5% in premenopausal symptomatic women and 49.3% in asymptomatic ones. Data for postmenopausal women were 38.3% and 56.7%, respectively. Prevalence of endometrial cancer was 1% in premenopausal and 6.2% in postmenopausal women. We found no significant correlation between endometrial cancer and tamoxifen treatment. The only significant finding was an increased prevalence of endometrial polyps in women treated with tamoxifen compared with general population: 43.2% versus 13.5% (p <0.001).
Hysteroscopy and Pelvic Ultrasound in Women With Abnormal Uterine Bleeding R Consonni, L Redaelli, E Bonaccorsi, A Pasini, C Belloni. Department of Obstetrics and Gynecology, Valduce Hospital, Como, Italy.
From 1988 to 1994 we evaluated 1350 women with abnormal uterine bleeding by hysteroscopy with endometrial sampling, and transvaginal ultrasound. Of these, 889 were premenopausal and 461 were postmenopausal. Criteria for ultrasound diagnosis of endometrial pathology were endometrial thickness, presence of intracavitary projections, cystic areas, and irregular endometrial rime. In premenopausal women with positive ultrasound, we found normal endom e t r i u m in 47.1%, benign endometrial lesions in 51.1%, and endometrial cancer in 0.9%. In patients with negative ultrasound we found normal endometrium in 67.2%, benign pathology in 31.1%, endometrial pathology in 0.7%, and endometrial cancer in 5.4%. In women with negative ultrasound the figures were normal endometrium 77.8%, benign pathology 21.1%, and endometrial cancer 1.1%. In premenopausal women the sensitivity, specificity, and negative predictive value of ultrasound for endometrial cancer were 71%, 34.8%, and 99.3%, respectively; in postmenopausal women they were 95%, 21.4%, and 98.9%, respectively. Pelvic ultrasound is less invasive than hysteroscopy with biopsy and can be an alternative in
Hysteroscopic Evaluation in Women Treated With Tamoxifen for Breast Cancer R Consonni, A Pasini, C Belloni. Department of Obstetrics and Gynecology, Valduce Hospital, Como, Italy.
From 1988 to 1994, 37 women treated with tamoxifen for breast cancer were evaluated for endometrial pathology by office hysteroscopy and endometrial biopsy. The mean treatment period was 36.4 months (range 1-120 mo). Nine patients (24.3%) had abnormal
SIO
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
metroplasty four biopsies were taken, two from the septum and two from the wall of the uterus. Thirteen characteristics were studied and scored with regard to connective tissue (4), muscles (4), and vessels (5). For statistical analysis the mean ridit and Bonferroni criterion for multiple comparisons were used. Contrary to former belief, the study revealed a smaller amount of connective tissue (p <0.001) and more muscle interlacing (p <0.05), amount of muscle (p <0.025), and vessels with a muscle wall (p <0.005) in the septum. This suggests that the reason for the spontaneous abortion in patients with septate uterus is not fewer vessels in the septum, but less connective tissue and more muscle in the septum.
postmenopausal women with abnormal uterine bleeding or for screening in asymptomatic patients.
Endometriai Resection versus Vaginal Hysterectomy for the Surgical Treatment of Menorrhagia PG Crosignani, P Vercellini, O De Giorgi, G Aimi, I Cortesi, M Meschia. Obstetric and Gynecological Clinic, "Luigi Mangiagalli," University of Milan, Milan, Italy.
To evaluate the efficacy of treatment with endometrial resection versus vaginal hysterectomy in patients with established menorrhagia, 85 women under age 50 years were recruited in an open-label, randomized, clinical trial. Eligible subjects had a mobile uterus with a volume less than a 12-week pregnancy, and no adnexal tumors or submucous myomas with a diameter greater than 3 cm. The patients were asked to grade the degree of satisfaction with their treatment and any modifications in sexual activity 1 year after surgery. Median (interquartile range, IR) operating time was, respectively, 13 minutes (10-15 min) in the endometrial resection group (group 1,41 women) and 71 minutes (66-78 min) in the hysterectomy group (group 2, 44 women). No important complications occurred. Median number of days to return to normal activities and to work were, respectively, 8 (IR 6-8) and 14 (]R 11-16) days in group 1 versus 13 (IR 13-15) and 30 (IR 26-34) in group 2. Four women in group 1 subsequently underwent vaginal hysterectomy, two for recurrent menorrhagia, one for dysmenorrhea, one for atypical hyperplasia. Among the 82 women attending the 1-year follow-up visit, 34 (87%) of those in group 1 were very satisfied or satisfied with their treatment compared with 41 (95%) of those in group 2 (NS). Sexual activity was unchanged in 32 (84%) subjects in the former versus 33 (85%) women in the latter group. Endometrial resection and vaginal hysterectomy seem to be equally effective at 1 year after surgery for menorrhagia.
Hysteroscopic Excision of the Uterine Septum: Is Estrogen Required? H Dabirashrafi, K Mohammad, N Moghadami-Tabrizi, K Zandinejad. Endoscopy and Fertility Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Of 39 women with septate uterus undergoing hysteroscopic excision of the septum, 18 were randomized to receive conjugated estrogen for 1 month after the operation (group 1) and 21 to receive no estrogen (group 2). One month after the operation a second hysterosalpingogram (HSG) was performed in all patients and compared with the preoperative HSG. The comparisons involved the following: from the midpoint of an imaginary line between the two ostia two measurements were taken, (a and a 1) to the tip of the septurn and (b and b ~) to the internal os. Then the proportion of a/b - al/b 1was determined (a/b from the HSG before and al/b 1 from the HSG after the operation). The mean of the totals of the calculated proportions in groups 1 and 2 were compared with the t test. The statistics were 0.35 in group 1 and 0.27 in group 2. There were no significant differences between the groups (t = 1.26).
Final Report About New Concepts of Pathology of the Septum in Septate Uterus
Hysteroscopic Endometrial "Ploughing" for Complete Endometrial Fibrosis
H Dabirashrafi, M Bahadori, K Mohammad, M Alavi, N Moghadami-Tabrizi, K Zandinejad. Endoscopy and Fertility Research Center, Tehran University of Medical Sciences, Tehran, Iran.
MP David, JR Cohen, D Luxman. Department of Obstetrics and Gynecology "B," Serlin Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.
Endometrial fibrosis can result from various pathologic causes, mainly endometritis and aggressive handling during curettage. Complete fibrosis of the endometrial lining is very rare, causing amenorrhea
Pathology reports in eight patients with septate uterus were disclosed originally at the 20th annual meeting of the AAGL. The final results of 16 patients confirms those tentative results. During Tompkins
Sll
Laparoscopic Management of Adnexal Postmenopausal Masses P Colombo, F Giambelli, I Sambruni, M Candiani, S De Marinis, M Busacca. 2nd Department of Obstetrics and Gynecology, "L. Mangiagalli," University of Milan, Milan, Italy.
Laparoscopic treatment of ovarian masses remains controversial. We strongly suggest that laparoscopic diagnosis of adnexal postmenopausal cysts can be safe, reliable, and successful. Until a few years ago, radical treatment by laparotomy was recommended for palpable ovaries in postmenopausal women because of the high risk of malignancy. We think that accurate preoperative screening together with strict intraoperative criteria can discriminate benign from malignant adnexal masses. Many sophisticated technologies are available to evaluate ovarian pathology, such as laboratory tests, ultrasound, color Doppler, computerized tomography, and magnetic resonance imaging. They allow more accuracy in patient selection for laparoscopy, which remains the major tool in the diagnosis of adnexal masses. Between June 1993 and October 1994 we treated 18 postmenopausal women with adnexal cysts by laparoscopy. Patients were selected following strict criteria of evaluation to exclude malignancies. The first step was careful history and physical examination, ultrasound evaluation with vaginal probe, and serum CA125 measurement. The second step was laparoscopic diagnosis with cytologic examination of the peritoneal fluid and accurate inspection of the entire abdominal cavity. We always performed bilateral adnexectomy with intraoperative frozen sections; in case of malignancy we performed an immediate laparotomy. The adnexae were extracted by abdominal endopatch to avoid spillage and dissemination. In our series no adnexal cancer was misdiagnosed, and laparoscopic treatment was performed only for benign masses.
uterine bleeding and 28 (75.7%) were asymptomatic. Hysteroscopy detected endometrial pathology (polyps, endometrial hyperplasia, neoplasm) in 21 patients (56.8%). The prevalence of the pathology was 66.7% in symptomatic patients (6/9) and 53.6% in asymptomatic ones. We found an endometrial neoplasm in 3 (8.6%) of 35 symptomatic postmenopausal women. In the same period we evaluated 3064 premenopausal and 1428 postmenopausal women by office hysteroscopy. The prevalence of endometrial pathology was 36.5% in premenopausal symptomatic women and 49.3% in asymptomatic ones. Data for postmenopausal women were 38.3% and 56.7%, respectively. Prevalence of endometrial cancer was 1% in premenopausal and 6.2% in postmenopausal women. We found no significant correlation between endometrial cancer and tamoxifen treatment. The only significant finding was an increased prevalence of endometrial polyps in women treated with tamoxifen compared with general population: 43.2% versus 13.5% (p <0.001).
Hysteroscopy and Pelvic Ultrasound in Women With Abnormal Uterine Bleeding R Consonni, L Redaelli, E Bonaccorsi, A Pasini, C Belloni. Department of Obstetrics and Gynecology, Valduce Hospital, Como, Italy.
From 1988 to 1994 we evaluated 1350 women with abnormal uterine bleeding by hysteroscopy with endometrial sampling, and transvaginal ultrasound. Of these, 889 were premenopausal and 461 were postmenopausal. Criteria for ultrasound diagnosis of endometrial pathology were endometrial thickness, presence of intracavitary projections, cystic areas, and irregular endometrial rime. In premenopausal women with positive ultrasound, we found normal endom e t r i u m in 47.1%, benign endometrial lesions in 51.1%, and endometrial cancer in 0.9%. In patients with negative ultrasound we found normal endometrium in 67.2%, benign pathology in 31.1%, endometrial pathology in 0.7%, and endometrial cancer in 5.4%. In women with negative ultrasound the figures were normal endometrium 77.8%, benign pathology 21.1%, and endometrial cancer 1.1%. In premenopausal women the sensitivity, specificity, and negative predictive value of ultrasound for endometrial cancer were 71%, 34.8%, and 99.3%, respectively; in postmenopausal women they were 95%, 21.4%, and 98.9%, respectively. Pelvic ultrasound is less invasive than hysteroscopy with biopsy and can be an alternative in
Hysteroscopic Evaluation in Women Treated With Tamoxifen for Breast Cancer R Consonni, A Pasini, C Belloni. Department of Obstetrics and Gynecology, Valduce Hospital, Como, Italy.
From 1988 to 1994, 37 women treated with tamoxifen for breast cancer were evaluated for endometrial pathology by office hysteroscopy and endometrial biopsy. The mean treatment period was 36.4 months (range 1-120 mo). Nine patients (24.3%) had abnormal
SIO
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
metroplasty four biopsies were taken, two from the septum and two from the wall of the uterus. Thirteen characteristics were studied and scored with regard to connective tissue (4), muscles (4), and vessels (5). For statistical analysis the mean ridit and Bonferroni criterion for multiple comparisons were used. Contrary to former belief, the study revealed a smaller amount of connective tissue (p <0.001) and more muscle interlacing (p <0.05), amount of muscle (p <0.025), and vessels with a muscle wall (p <0.005) in the septum. This suggests that the reason for the spontaneous abortion in patients with septate uterus is not fewer vessels in the septum, but less connective tissue and more muscle in the septum.
postmenopausal women with abnormal uterine bleeding or for screening in asymptomatic patients.
Endometriai Resection versus Vaginal Hysterectomy for the Surgical Treatment of Menorrhagia PG Crosignani, P Vercellini, O De Giorgi, G Aimi, I Cortesi, M Meschia. Obstetric and Gynecological Clinic, "Luigi Mangiagalli," University of Milan, Milan, Italy.
To evaluate the efficacy of treatment with endometrial resection versus vaginal hysterectomy in patients with established menorrhagia, 85 women under age 50 years were recruited in an open-label, randomized, clinical trial. Eligible subjects had a mobile uterus with a volume less than a 12-week pregnancy, and no adnexal tumors or submucous myomas with a diameter greater than 3 cm. The patients were asked to grade the degree of satisfaction with their treatment and any modifications in sexual activity 1 year after surgery. Median (interquartile range, IR) operating time was, respectively, 13 minutes (10-15 min) in the endometrial resection group (group 1,41 women) and 71 minutes (66-78 min) in the hysterectomy group (group 2, 44 women). No important complications occurred. Median number of days to return to normal activities and to work were, respectively, 8 (IR 6-8) and 14 (]R 11-16) days in group 1 versus 13 (IR 13-15) and 30 (IR 26-34) in group 2. Four women in group 1 subsequently underwent vaginal hysterectomy, two for recurrent menorrhagia, one for dysmenorrhea, one for atypical hyperplasia. Among the 82 women attending the 1-year follow-up visit, 34 (87%) of those in group 1 were very satisfied or satisfied with their treatment compared with 41 (95%) of those in group 2 (NS). Sexual activity was unchanged in 32 (84%) subjects in the former versus 33 (85%) women in the latter group. Endometrial resection and vaginal hysterectomy seem to be equally effective at 1 year after surgery for menorrhagia.
Hysteroscopic Excision of the Uterine Septum: Is Estrogen Required? H Dabirashrafi, K Mohammad, N Moghadami-Tabrizi, K Zandinejad. Endoscopy and Fertility Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Of 39 women with septate uterus undergoing hysteroscopic excision of the septum, 18 were randomized to receive conjugated estrogen for 1 month after the operation (group 1) and 21 to receive no estrogen (group 2). One month after the operation a second hysterosalpingogram (HSG) was performed in all patients and compared with the preoperative HSG. The comparisons involved the following: from the midpoint of an imaginary line between the two ostia two measurements were taken, (a and a 1) to the tip of the septurn and (b and b ~) to the internal os. Then the proportion of a/b - al/b 1was determined (a/b from the HSG before and al/b 1 from the HSG after the operation). The mean of the totals of the calculated proportions in groups 1 and 2 were compared with the t test. The statistics were 0.35 in group 1 and 0.27 in group 2. There were no significant differences between the groups (t = 1.26).
Final Report About New Concepts of Pathology of the Septum in Septate Uterus
Hysteroscopic Endometrial "Ploughing" for Complete Endometrial Fibrosis
H Dabirashrafi, M Bahadori, K Mohammad, M Alavi, N Moghadami-Tabrizi, K Zandinejad. Endoscopy and Fertility Research Center, Tehran University of Medical Sciences, Tehran, Iran.
MP David, JR Cohen, D Luxman. Department of Obstetrics and Gynecology "B," Serlin Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.
Endometrial fibrosis can result from various pathologic causes, mainly endometritis and aggressive handling during curettage. Complete fibrosis of the endometrial lining is very rare, causing amenorrhea
Pathology reports in eight patients with septate uterus were disclosed originally at the 20th annual meeting of the AAGL. The final results of 16 patients confirms those tentative results. During Tompkins
Sll