- Email: [email protected]
Laparoscopic management of adnexal postmenopausal masses
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
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