[Use of hysteroscopy, ultrasonography and selected hormonal tests for diagnosis of hyperplastic endometrial changes].

THE PURPOSE OF THE STUDY: 1. Diagnostic value of ultrasonic endometrium thickness measurement and estimation of ultrasonic endometrium qualitative features in detecting of pathological changes at women in perimenopausal period. 2. Estimation of comparative estrogens and testosterone level in diagnostic of endometrial changes at women in postmenopausal period. 3. Qualification usefulness of analysis of macroscopic hysteroscopy uterine cavity image in detecting of pathological changes at women in perimenopausal period. 4. Comparative analysis of fractional curettage and hysteroscopy as a method of receiving material from uterus to histological estimation at women in perimenopausal period. Material to investigations consist of 242 patients in age 40-86 years, which were divided into groups in dependence from obtained diagnosis on the ground histological estimation sampling received from uterus (BZ--"without changes", M--submucosus myomas, P--endometrial polyps, H--endometrial hyperplasia, CA--endometrial carcinoma). In all of women transvaginal ultrasonic estimation of endometrium (TVS) and fractional curettage were executed. In 160 from them also hysteroscopy with endometrial biopsy was performed. In 53 women in postmenopausal period not using of hormonal replacement therapy one marked concentration estron (E1), estradiol (E2) and testosterone (T) in serum of blood. TVS were performed using a transducer with an emission frequency of 7.0 MHz (B & K Medical 3535). Serum concentration of testosterone and estradiol were executed with EIA assay, however concentration of estron with RIA assays. To endoscopic investigations diagnostic and operative hysteroscops and resectoscope were used. Average thickness of endometrium in group CA, H and P (properly 8.96 and 6.09 and 5.02 mm) showed essential differences in comparison with group BZ (3.38 mm, Tab. 1). In group CA and H greatest cumulation of abnormal features of TVS image (endometrial thickness > 2.5 mm, hyperechoic, heterogeneous and containing cystic spaces endometrium, deformation of middle echo, indistinctness of endo-myometrial border, presence of focal changes in structure of endometrium and presence of fluid in uterine cavity > 1 cm3) was ascertained (Tab. 2, 3, 4). Hysteroscopic macroscopic image showed conformity with histological estimation in groups BZ, M, P, H and CA properly in 78.35, 93.75, 88.33, 22.22 and 88.33% (Tab. 7). On base of histological estimation 159 (65.7% of chances) of pathological changes (P-68, CA-37, M-32, H-22 chances) were detected (Tab. 8). Among them were 41 of asymptomatic chances (P-24, M-7, H-6, CA-4 chances). In hysteroscopy, all but one chance of pathological changes were detected, however curettage skipped most of focal changes.

CONCLUSIONS: 1. Ultrasonic measurement of endometrial thickness is sensitive index in detecting cancer and pathological endometrial hyperplasia, instead possesses smaller value in detecting of endometrial polyps and endometrial myomas. 2. Connection of measurement of endometrial thickness with estimation of qualitative features of endometrial and uterine cavity TVS image improves results of detecting all of types intrauterine pathology. 3. Dependence between estrogens level and with thickness of endometrium was confirmed. Practical value of hormonal estimations in diagnostics of endometrial pathological changes is however not large. 4. Analysis of hysteroscopic picture is characterised high agreement with histological investigation with reference to endometrial cancer, endometrial polyps and submucosus myomas. 5. Hysteroskopy with direct biopsy possesses superiority over curettage in detecting all of types of intrauterine pathology, in particular focal changes. 6. Hysteroscopy should determine method of choice at women with recurrent bleedings from uterus, which with curettage pathological changes did not detect.