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Abstract(s)
Introdução: A histeroscopia é um procedimento seguro no estudo da cavidade intrauterina, a
ser realizada na primeira fase do ciclo menstrual. Os avanços tecnológicos contribuíram para a
sua maior aceitação como exame complementar de diagnóstico e terapêutica. É considerada o
“gold standard” na abordagem de diversas lesões benignas e as suas indicações têm-se
multiplicado. Pretende-se avaliar a sensibilidade e especificidade da histeroscopia, identificar
as principais indicações para a sua realização e as patologias mais frequentes, por faixa etária
e estado menopáusico.
Metodologia: Estudo retrospetivo de 1038 histeroscopias realizadas no Centro Hospitalar Cova
da Beira, entre o mês de janeiro de 2012 e maio de 2017. Na análise estatística foram utilizados
os softwares SPSS® e MedCalc®.
Resultados: A idade média das pacientes é de 54,75±13,69 anos, variando dos 20 aos 96 anos.
Observou-se que 61,0% das pacientes estava na pós-menopausa e 39,0% na pré-menopausa. A
indicação mais prevalente para histeroscopia foi o diagnóstico e tratamento de patologia
uterina suspeita por outra técnica (53,4%; n=697). Obteve-se um exame bem-sucedido em 93,4%
dos casos. O endométrio atrófico (30,8%; n=575) foi o achado histeroscópico mais comum.
Comparou-se o diagnóstico histeroscópico com o resultado histológico em 742 casos. O
diagnóstico histopatológico mais frequente foi o pólipo endometrial (51,2%; n=380). A
hiperplasia endometrial predomina nas faixas etárias menores (= 59 anos) e, como o pólipo
endometrial, na pós-menopausa. As neoplasias foram detetadas em idades superiores a 50 anos
e na pós-menopausa. A especificidade do exame é elevada (87,3%-99,9%) e a sua sensibilidade
é significativa na maioria dos achados.
Discussão: A principal indicação para a histeroscopia não corresponde ao descrito na literatura,
onde a hemorragia uterina anormal é a motivação primária para a sua realização. O insucesso
do exame (6,6%; n=68) associa-se a dor (48,5%; n=33) e a estenose cervical (33,8%; n=23),
estando de acordo com outros trabalhos. Os diagnósticos histeroscópicos diferem de outros
estudos, provavelmente devido à média de idades superior na nossa investigação. A
sensibilidade e especificidade podem ter sido influenciadas pela simplificação de relatórios
anatomopatológicos e pela não confirmação histológica de todos os achados. Os valores obtidos
no caso da neoplasia corroboram os resultados encontrados noutros estudos.
Conclusões: A histeroscopia é um exame seguro e útil com bons resultados, embora não 100%
sensível. O estudo deu resposta aos objetivos propostos. Sugere-se fazer uma investigação
prospetiva com critérios definidos com o patologista, com confirmação anatomopatológica de
todos os achados histeroscópicos e com uma amostra maior.
Introduction: Hysteroscopy is a safe procedure in the study of the intrauterine cavity, to be performed in the first phase of the menstrual cycle. Technological advances have contributed to its greater acceptance as a complementary diagnostic and therapeutic examination. It is considered the “gold standard” in approaching several benign lesions and its indications have multiplied. The analysis will be focused on the sensibility and specificity of hysteroscopy, identify the principal indications of its realization and the most frequent pathologies, by age group and menopausal status. Methodology: A retrospective study of 1038 hysteroscopies performed at the Cova da Beira Hospital Center between January 2012 and May 2017. Statistical analysis was performed using SPSS® and MedCalc® software. Results: The average age of the patients is 54,75±13,69 years, ranging from 20 to 96 years. It was observed that 61,0% of patients were postmenopausal and 39,0% premenopausal. The most prevalent indication for hysteroscopy was the diagnosis and treatment of uterine pathology suspected by another technique (53,4%; n=697). A successful examination was obtained in 93,4% of cases. The atrophic endometrium (30,8%; n=575) was the most common hysteroscopic finding. The hysteroscopic diagnosis was compared with the histological result in 742 cases. The most frequent histopathological diagnosis was the endometrial polyp (51,2%, n=380). Endometrial hyperplasia predominates in the younger age groups (= 59 years) and, like the endometrial polyp, in postmenopausal age. Cancer were detected at ages greater than 50 years and in postmenopausal. The specificity of the test is high (87,3%-99,9%) and its sensibility is significant in most of the findings. Discussion: The main indication for hysteroscopy does not correspond to the one described in the literature, where abnormal uterine bleeding is the primary motivation for its accomplishment. The failure of the exam (6,6%, n=68) was associated with pain (48,5%, n=33) and cervical stenosis (33,8%; n=23), being in agreement with other studies. Hysteroscopic diagnoses differ from other studies, probably because the average age is higher in our investigation. Sensibility and specificity may have been influenced by the simplification of anatomopathological reports and non-histological confirmation of all findings. The values obtained in the case of cancer corroborate the results found in other studies. Conclusions: Hysteroscopy is a safe and useful examination with good results, although not 100% sensitive. The study responded to the proposed objectives. It is suggested to perform a prospective investigation with defined criteria with the pathologist, with anatomopathological confirmation of all hysteroscopic findings and with a larger sample.
Introduction: Hysteroscopy is a safe procedure in the study of the intrauterine cavity, to be performed in the first phase of the menstrual cycle. Technological advances have contributed to its greater acceptance as a complementary diagnostic and therapeutic examination. It is considered the “gold standard” in approaching several benign lesions and its indications have multiplied. The analysis will be focused on the sensibility and specificity of hysteroscopy, identify the principal indications of its realization and the most frequent pathologies, by age group and menopausal status. Methodology: A retrospective study of 1038 hysteroscopies performed at the Cova da Beira Hospital Center between January 2012 and May 2017. Statistical analysis was performed using SPSS® and MedCalc® software. Results: The average age of the patients is 54,75±13,69 years, ranging from 20 to 96 years. It was observed that 61,0% of patients were postmenopausal and 39,0% premenopausal. The most prevalent indication for hysteroscopy was the diagnosis and treatment of uterine pathology suspected by another technique (53,4%; n=697). A successful examination was obtained in 93,4% of cases. The atrophic endometrium (30,8%; n=575) was the most common hysteroscopic finding. The hysteroscopic diagnosis was compared with the histological result in 742 cases. The most frequent histopathological diagnosis was the endometrial polyp (51,2%, n=380). Endometrial hyperplasia predominates in the younger age groups (= 59 years) and, like the endometrial polyp, in postmenopausal age. Cancer were detected at ages greater than 50 years and in postmenopausal. The specificity of the test is high (87,3%-99,9%) and its sensibility is significant in most of the findings. Discussion: The main indication for hysteroscopy does not correspond to the one described in the literature, where abnormal uterine bleeding is the primary motivation for its accomplishment. The failure of the exam (6,6%, n=68) was associated with pain (48,5%, n=33) and cervical stenosis (33,8%; n=23), being in agreement with other studies. Hysteroscopic diagnoses differ from other studies, probably because the average age is higher in our investigation. Sensibility and specificity may have been influenced by the simplification of anatomopathological reports and non-histological confirmation of all findings. The values obtained in the case of cancer corroborate the results found in other studies. Conclusions: Hysteroscopy is a safe and useful examination with good results, although not 100% sensitive. The study responded to the proposed objectives. It is suggested to perform a prospective investigation with defined criteria with the pathologist, with anatomopathological confirmation of all hysteroscopic findings and with a larger sample.
Description
Keywords
Análise Histopatológica Especificidade Histeroscopia Diagnóstica Patologia Intrauterina Sensibilidade