Diagnostik und Therapie benigner und prämaligner Veränderungen des Endometriums

Kernaussagen

Benigne oder prämaligne Veränderungen des Endometriums werden bei der normalen gynäkologischen Untersuchung meist nebenbefundlich erkannt. Goldstandard der Diagnostik ist die Sonografie, die im Idealfall ergänzt wird durch die diagnostische Hysteroskopie. Sie ermöglicht in den meisten Fällen auch die genaue Lokalisation bspw. einer Postmenopausenblutung. Zugleich kann die Hysteroskopie auch therapeutisch genutzt werden, um z. B. Polypen durch Kürettage oder mit der Fasszange zu entfernen, was mit der Abrasio allein nicht immer zufriedenstellend erfolgt. Allerdings ist bei der Therapie der Korpuspolypen die elektrochirurgische Schlingenresektion mittlerweile das am häufigsten eingesetzte Verfahren mit der geringsten Rezidivrate. Auch das Asherman-Syndrom wird meist hysteroskopisch behandelt. Bei Endometriumhyperplasien und -karzinomen besteht die Therapie in der Hysterektomie, ggf. mit Adnexexstirpation. Endometritiden laufen oft oligosymptomatisch, aber z. T. auch asymptomatisch ab und sind je nach vorherrschendem Krankheitsbild mit spezifischer Antibiose, ggf. auch wiederholt zu behandeln.

• Literatur

• 1 Goldstein RB, Bree RL, Benson CB et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement. J Ultrasound Med 2001; 20: 1025-1036
• 2 Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North America 2003; 41: 769-780
• 3 Jacobs I, Gentry-Maharaj A, Burnell M et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol 2011; 12: 38-48
• 4 Smith-Bindman R, Kerlikowske K, Feldstein VA et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. J Am Med Assoc 1998; 280: 1510-1517
• 5 Tabor A, Watt HC, Wald NJ. Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding. Obstet Gynecol 2002; 99: 663-670
• 6 Clark TJ, Barton PM, Coomarasamy A et al. Investigating postmenopausal bleeding for endometrial cancer: cost-effectiveness of initial diagnostic strategies. Br J Obstet Gynaecol 2006; 113: 502-510
• 7 Timmermans A, Opmeer BC, Khan KS et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 2010; 116: 160-167
• 8 Lethaby A, Suckling J, Barlow D et al. Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev 2004; (3) CD000402
• 9 Van den Bosch T, Van Schoubroeck D, Ameye L et al. Ultrasound assessment of endometrial thickness and endometrial polyps in women on hormonal replacement therapy. Am J Obstet Gynecol 2003; 188: 1249-1253
• 10 Griffin Y, Sudigali V, Jacques A. Radiology of benign disorders of menstruation. Semin Ultrasound CT MR 2010; 31: 414-432
• 11 Wieser F, Tempfer C Kurz C,. Hysteroscopy in 2001: a comprehensive review. Acta Obstet Gynecol Scand 2001; 80: 773-783
• 12 Mencaglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med 1987; 32: 577-582
• 13 Nagele F, OʼConnor H, Davies A et al. 2500 Outpatient diagnostic hysteroscopies. Obstet Gynecol 1996; 88: 87-92
• 14 Pal L, Lapensee L, Toth TL. Comparison of office hysteroscopy, transvaginal ultrasonography and endometrial biopsy in evaluation of abnormal uterine bleeding. J Soc Laparoscop Surg 1997; 1: 125-130
• 15 Cacciatore B, Ramsay T, Lehtovirta P. Transvaginal sonography and hysteroscopy in postmenopausal bleeding. Acta Obstet Gynecol Scand 1994; 73: 413-416
• 16 Torrejon R, Fernandez-Alba JJ, Carnicer I et al. The value of hysteroscopic exploration for abnormal uterine bleeding. J Am Assoc Gynecol Laparoscopists 1997; 4: 453-456
• 17 Ceci O, Bettocchi S, Pellegrino A et al. Comparison of hysteroscopic and hysterectomy findings for assessing the diagnostic accuracy of office hysteroscopy. Fertil Steril 2002; 78: 628-631
• 18 Clark TJ, Voit D, Gupta JK et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. J Am Med Assoc 2002; 288: 1610-1621
• 19 Elfayomy AK, Habib FA, Alkabalawy MA. Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium. Arch Gynecol Obstet 2012; 285: 839-843
• 20 Sainz de la Cuesta R, Espinosa JA, Crespo E et al. Does fluid hysteroscopy increase the stage or worsen the prognosis in patients with endometrial cancer? A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2004; 115: 211-215
• 21 Cicinelli E, Tinelli R, Colafiglio G et al. Risk of long-term pelvic recurrences after fluid mini hysteroscopy in women with endometrial carcinoma: a controlled randomized study. Menopause NY 2010; 17: 511-515
• 22 Dreisler E, Poulsen LG, Antonsen SL et al. EMAS clinical guide: Assessment of the endometrium in peri and postmenopausal women. Maturitas 2013; 75: 181-190
• 23 Juhasz-Boss I, Fehm T, Nauth A et al. Number of hysteroscopies and the time interval between hysteroscopy and surgery: influence on peritoneal cytology in patients with endometrial cancer. Anticancer Res 2010; 30: 2425-2430
• 24 Lewis BV. Hysteroscopy in gynaecological practice: a review. J Royal Soc Med 1984; 77: 235-237
• 25 Brooks PG, Serden SP. Hysteroscopic findings after unsuccessful dilatation and curettage for abnormal uterine bleeding. Am J Obstet Gynecol 1988; 158: 1354-1357
• 26 Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol 1975; 45: 537-541
• 27 Madari S, Al-Shabibi N, Papalampros P et al. A randomised trial comparing the H Pipelle with the standard Pipelle for endometrial sampling at ‘no-touch (vaginoscopic) hysteroscopy. Br J Obstet Gynaecol 2009; 116: 32-37
• 28 Dantas MC, Hidalgo MM, Bahamondes L, Marchi NM. A comparison of the performance of endometrial biopsy with the Pipelle by nurses and physicians. Int J Gynecol Obstet 1994; 45: 164-165
• 29 Antoni J, Folch E, Costa J et al. Comparison of cytospat and pipelle endometrial biopsy instruments. Eur J Gynecol Reprod Biol 1997; 72: 57-61
• 30 Dijkhuizen FP, Mol BW, Brolmann HA. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89: 1765-1772
• 31 Newell S, Overton C. Postmenopausal bleeding should be referred urgently. The Practitioner 2012; 256: 13-15
• 32 Elfayomy AK, El Tarhouny SA. Ovarian volume assessment in relation to histologic findings and sex hormone levels in women with postmenopausal bleeding and thickened endometrium. Ann Saudi Med 2012; 32: 588-592
• 33 Null DB, Weiland CM, Camlibel AR. Postmenopausal bleeding-first steps in the workup. J Fam Pract 2012; 61: 597-604
• 34 Gerber B. Stellenwert der Hysteroskopie und fraktionierten Abrasio in der Abkla¨rung von Postmenopausenblutungen. Geburtsh Frauenheilkd 1998; 58: 440-445
• 35 Janni W, Rach B, Friese K Hrsg. Facharzt Gynäkologie. München: Elsevier; 2008
• 36 Deligdisch L. Effects of hormone therapy on the endometrium. Mod Pathol 1993; 6: 94-106
• 37 Ivanova V, Karaivanov M, Marinov E et al. [Pathology of the endometrium in breast cancer patients treated with tamoxifen (nolvadex)]. Akusherstvo i ginekologiia 2003; 42: 3-8
• 38 DeWaay DJ, Syrop CH, Nygaard IE et al. Natural history of uterine polyps and leiomyomata. Obstet Gynecol 2002; 100: 3-7
• 39 Goldstein SR, Monteagudo A, Popiolek D et al. Evaluation of endometrial polyps. Am J Obstet Gynecol 2002; 186: 669-674
• 40 Orvieto R, Bar-Hava I, Dicker D et al. Endometrial polyps during menopause: characterization and significance. Acta Obstet Gynecol Scand 1999; 78: 883-886
• 41 Reslova T, Tosner J, Resl M et al. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133-139
• 42 Hassa H, Tekin B, Senses T et al. Are the site, diameter, and number of endometrial polyps related with symptomatology?. Am J Obstet Gynecol 2006; 194: 718-721
• 43 Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. J Soc Laparoendoscop Surg 2004; 8: 103-107
• 44 Silberstein T, Saphier O, van Voorhis BJ. Endometrial polyps in reproductive-age fertile and infertile women. Isr Med Assoc J 2006; 8: 192-195
• 45 Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2008; 89: 1-16
• 46 Römer T. Hysteroskopischer Wegweiser für Gynäkologen. 2.. Aufl. Berlin: Walter De Gruyter; 2007
• 47 Ben-Arie A, Goldchmit C, Laviv Y et al. The malignant potential of endometrial polyps. Eur J Obstet Gynaecol Reprod Biol 2004; 115: 206-210
• 48 Savelli L, De Iaco P, Santini D et al. Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 2003; 188: 927-931
• 49 Gregoriou O, Konidaris S, Vrachnis N et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric 2009; 12: 454-458
• 50 Berzolla CE, Schnatz PF, OʼSullivan DM et al. Dysplasia and malignancy in endocervical polyps. J Womenʼs Health 2007; 16: 1317-1321
• 51 Mbatsogo BA, Le Bouedec G, Michy T et al. [Endometrial cancers arising in polyps associated with tamoxifen use]. Gynecol Obstet Fertil 2005; 33: 975-979
• 52 Antunes jr. A, Costa-Paiva L, Arthuso M et al. Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy. Maturitas 2007; 57: 415-421
• 53 Diedrich KHW, Jonat W. Gynäkologie und Geburtshilfe. Heidelberg, Berlin: Springer Verlag; 2000: 590-591
• 54 Nathani F, Clark TJ. Uterine polypectomy in the management of abnormal uterine bleeding: A systematic review. J Min Invasive Gynecol 2006; 13: 260-268
• 55 Lieng M, Qvigstad E, Sandvik L et al. Hysteroscopic resection of symptomatic and asymptomatic endometrial polyps. J Min Invasive Gynecol 2007; 14: 189-194
• 56 Hulka JF, Peterson HA, Phillips JM, Surrey MW. Operative hysteroscopy: American Association of Gynecologic Laparoscopists 1993 membership survey. J Am Assoc Gynecol Laparoscop 1995; 2: 131-132
• 57 Peterson HB, Hulka JF, Phillips JM. American Association of Gynecologic Laparoscopists 1988 membership survey on operative hysteroscopy. J Reprod Med 1990; 35: 590-591
• 58 Friedler S, Margalioth EJ, Kafka I. Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy – a prospective study. Hum Reprod (Oxford, England) 1993; 8: 442-444
• 59 Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril 1982; 37: 593-610
• 60 Burns JW, Skinner K, Colt J et al. Prevention of tissue injury and postsurgical adhesions by precoating tissues with hyaluronic acid solutions. J Surg Res 1995; 59: 644-652
• 61 Pace S, Stentella P, Catania R et al. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol 2003; 30: 26-28
• 62 Katz Z, Ben-Arie A, Lurie S et al. Reproductive outcome following hysteroscopic adhesiolysis in Ashermanʼs syndrome. Int J Fertil Menopausal Stud 1996; 41: 462-465
• 63 Denschlag D, Ulrich U, Emons G. The diagnosis and treatment of endometrial cancer: progress and controversies. Dtsch Arzteblatt Int 2011; 108: 571-577
• 64 Singh MN, Stringfellow HF, Paraskevaidis E et al. Tamoxifen: important considerations of a multi-functional compound with organ-specific properties. Cancer Treat Rev 2007; 33: 91-100
• 65 Gao WL, Zhang LP, Feng LM. Comparative study of transvaginal ultrasonographic and diagnostic hysteroscopic findings in postmenopausal breast cancer patients treated with tamoxifen. Chin Med J 2011; 124: 2335-2339
• 66 Fung MF, Reid A, Faught W et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 2003; 91: 154-159
• 67 Cicinelli E, Resta L, Nicoletti R et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod (Oxford, England) 2005; 20: 1386-1389
• 68 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. Morb Mortal Wkly Rep 2006; 55: 38-42
• 69 Chin J. Control of Communicable Diseases Manual. Washington: Am Public Health Assoc; 2000: 97-99
• 70 Center for Disease Control and Prevention. Update to CDCʼs Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. Morb Mortal Wkly Rep 2012; 61: 590-594
• 71 Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Syst Rev 2002; (3) CD000933
• 72 Wamsteker K, De Block S. Diagnostic Hysteroscopy: Technique and Documentation. In: Sutton C, Diamond M, eds. Endoscopic Surgery for Gynecologists. London: Saunders; 1998: 511-524