Функціональні та ендоскопічні методи діагностики внутрішньоматкової патології

Abstract

Endometrial pathology (EP) is one of the most common problems which complicate the life of women in the late reproductive, menopausal and postmenopausal periods. Today it is proved that EP acts as a premotor background on which cancer processes of the female reproductive system develop. A special role in the verification of EP belongs to non-invasive and invasive methods of investigation, the diagnostic value of which are not the same. The objective: to evaluate the diagnostic effectiveness of the main methods of verification of endometrial pathology in women in the late reproductive and postmenopausal periods. Materials and methods. A comprehensive examination of 162 women with endometrial pathology was conducted. In addition to conventional investigations for all patients at the first stage of the survey transabdominal and transvaginal ultrasonography (TVUSI), subsequent 3D\4D echographies in the sonoelastography (TV-SEG) regime were conducted. At the second stage of examination hysteroresectoscopy with subsequent histological verification of the obtained material was performed. Results. According TVUSI diagnosis of endometrial hyperplasia was set in 162 cases. In 76 patients (59.4%) non-typical form (NF) of EH was diagnosed. In 52 women (40.6%) the diagnosis of HE atypical form (AF) was set. The discrepancy between ultrasound and pathohistological diagnosis was observed in 34 (20.9%) patients. The frequency of EH diagnosis according to TV + SEG was 145 cases (89.5%), which is 10.5% less compared to TVUSI. Increased echogenicity of the endometrium was revealed in 58 (76.3%) women with NF EH, with AF EH this diagnostic criteria was established in 42 (80.1%) patients. Deformation of the uterine cavity relief was detected in 52 (68.4%) patients with NF HE in women with AF HE this ultrasound index was detected in 38 (73.1%) women. Uneven external contour of M-echo was determined in 8 (10.5%) women with NF HE and 14 (26.9%) women with AF HE (p<0.05). During hysteroresectoscopy HE was diagnosed in 154 cases (95.0%). Fibrous polyps were found characteristic for patients in the post- and premenopausal periods. Conclusion. The comparative analysis of diagnostic characteristics revealed that the addition of sonoelastography to ultrasound investigation can reduce the percentage of false results and increase the diagnostic sensitivity of ultrasound in the diagnosis of endometrial hyperplasia from 79.0% to 89.5%. The inclusion of hysteroresectoscopy to the diagnostic algorithm makes it possible to visualize the pathology of the endometrium and obtain a sighting biopsy. This makes it possible to increase the diagnostic sensitivity of ultrasound investigation by the means of sonoelastography from 89.5% to 95.0%. Key words: endometrial pathology, sonoelastography, endometrial hyperplasia, endometrial polyp, hysteroresectoscopy.