Hallazgos histeroscópicos en mujeres asintomáticas con ecografía sugestiva de patología endometrial / Hysteroscopic results in asymptomatic women with ultrasonographic findings suggestive of endometrial disease

RESUMEN

Objetivo. El objetivo principal de este estudio es conocer la prevalencia de hiperplasia con atipias y adenocarcinoma de endometrio que se detectan al realizar una histeroscopia en mujeres posmenopáusicas asintomáticas con ecografía vaginal sugestiva de patología endometrial. El objetivo secundario es conocer la utilidad de la histeroscopia en el diagnóstico de las lesiones premalignas y malignas en dichas mujeres. Sujetos y métodos. Estudio descriptivo de 1.237 histeroscopias practicadas en un periodo de 7 años (enero de 2000 a diciembre de 2006) en la Consulta de Ginecología. Todas estaban asintomáticas y fueron enviadas a nuestra consulta por una ecografía sugestiva de patología endometrial. Resultados. El hallazgo histeroscópico más frecuente es el de pólipo endometrial (64,3%), seguido por el diagnóstico de normalidad (15,7%). Se practicaron 1.046 biopsias de endometrio. Además, 27 pacientes fueron histerectomizadas. Se diagnosticaron 14 hiperplasias con atipias (1,13%) y 20 adenocarcinomas de endometrio en estadio I (1,61%). La histeroscopia tiene una alta especificidad y VPN para el diagnóstico de patología maligna y premaligna (E: 97,5%, VPN 99,6% y LR+ de 31,25). Conclusiones. La eficiencia de la ecografía transvaginal como cribado en la mujer menopáusica asintomática en el diagnóstico de patología endometrial premaligna y maligna, según nuestros resultados, no parece ser alta. La histeroscopia permite un diagnóstico fiable en este grupo de mujeres (AU)

ABSTRACT

Objective. The main objective of this study was to determine the prevalence of atypical hyperplasia and endometrial adenocarcinoma detected by hysteroscopy in asymptomatic postmenopausal women with vaginal ultrasonographic findings suggestive of endometrial disease. The second aim was to ascertain the usefulness of hysteroscopy in the diagnosis of premalignant and malignant lesions in these patients. Subjects and methods. We performed a descriptive study of 1,237 hysteroscopies carried out over a 7-year period (January 2000 to December 2006) in the Gynecology Department of Hospital Donostia. All the women were asymptomatic and were referred to our clinic due to an ultrasound examination suggestive of endometrial disease. Results. The most frequent hysteroscopic findings were endometrial polyps (64.3%), followed by a diagnosis of normality (15.7%). A total of 1,046 endometrial biopsies were performed. In addition, 27 patients underwent hysterectomy; 14 were diagnosed with atypical hyperplasia (1.13%) and 20 with stage I endometrial adenocarcinoma (1.61%). The specificity and negative predictive value of hysteroscopy in the diagnosis of premalignant and malignant lesions were high (specificity: 97.5%, negative predictive value 99.6%, positive likelihood ratio 31.25). Conclusions. The results of our study suggest that the efficiency of transvaginal ultrasound screening in asymptomatic menopausal women in the diagnosis of premalignant and malignant endometrial disease is not high. Hysteroscopy allows a reliable diagnosis in this group of women (AU)