Bodovni sustav u neinvazivnoj dijagnostici endometrioma jajnika : doktorska disertacija - Kopjar, Miroslav (Zagreb : M. Kopjar, 1996)
Sažetak: Endometrioza je benigna ginekološka bolest nepoznate etiologije. Od mnogobrojnih predloženih patofizioloških mehanizama, znanstveno je najutemeljeniji onaj o povratnoj menstruaciji. Ona se, međutim javlja i u velikom postotku (do 80%) zdravih žena, te svakako imunološki uvjeti, među kojima naročito peritonealni makrofagi svakako imaju značajnu ulogu. Jajnici i stražnji list širokog ligamenta najčešća su sijela endometriotičkog procesa, a lijeva je strana zahvaćena češće nego desna. Zbog širokog raspona mogućih lezija točna dijagnoza je od velikog kliničkog značenja. Prema mnogim studijama direktan prikaz prilikom operacijskog zahvata smatra se najpouzdanijim načinom dokazivanja endometriotičke lezije.
S ciljem izbjegavanja kirurške traume i iznalaženja nove, neinvazivne metode otkrivanja i praćenja bolesti proveli smo trogodišnju prospektivnu studiju koristeći kombinirani bodni sistem zasnovan na obojenom i pulzirajućem doplerskom pregledu. Uključeno je 887 bolesnica s adneksalnim tvorbama. Njih 451 bilo je operirano laparotomijom, a 436 laparoskopskim putem. Ispitanice su bile između 18 i 78 godina starosti, srednja dob iznosila je 47 godina. Njih 98 (11.05%) bilo je u postmenopauzi. Kriteriji kojima se služi kombinirani bodni sistem bili su: dob bolesnice, klinička slika adneksalne tvorbe, vrijednosti CA-125 u serumu, ultrazvučni nalaz, te nalaz obojenog i pulzirajućeg doplera. Rezultati ovog bodnog sistema uspoređeni su s intraoperacijskim nalazom, dok se histopatološka dijagnoza smatrala konačnom.
Endometriotičke ciste jajnika imale su široke stjenke s vidljivim unutrašnjim sjenama u 163 ispitanice (83.16%), multilokularne cistične strukture nađene su u 14 (7.14%) bolesnica, a solidno-cističan izgled primjećen je u 19 (9.69%) bolesnica. Srednja vrijednost promjera ciste iznosila je 55.8 mm (raspon 18 do 170 mm). Obostrane lezije otkrivene su u 76.53 % ispitanica. Korištenjem samo parametara dvodimenzionalnog ultrazvučnog prikaza postignuta je osjetljivost od 90.82%, svojevrsnost 97.11%, te pozitivna prediktivna vrijednost od 89.45%, dok je negativna prediktivna vrijednost bila 97.51%. Kombinirani bodni sistem imao je osjetljivost 99.70%, svojevrsnost 98.97%, pozitivnu prediktivnu vrijednost 98.47% i negativnu prediktivnu vrijednost 98.82%.
Zaključili smo da je kombinirani bodni sistem zasnovan na obojenom i pulzirajućem doplerskom pregledu pouzdana metoda u otkrivanju i razlikovanju endometriotičkih cisti od ostalih benignih i malignih tvorbi u maloj zdjelici.
Abstract: Although endometriosis is a common benign gynecological condition, there still is much to learn about its etiology and pathogenesis. Retrograde menstruation seems to be the most probable explanation for pathogenesis. Peritoneal macrophages and other immunological factors also contribute, but further investigations are obligate for estimation of the real meaning of those factors. The ovaries and posterior leaf of the broad ligaments are the most frequent locations and the left side is more frequently affected than the right one. The condition has aroused much interest and controversy in recent years with regard to its accurate diagnosis, infertility, and proper treatment.
Even with the recent and ongoing achievements in operative endoscopy, clinicans are still faced with a problem of correct diagnosis, both in the sense of missing this pathology treating a luteinic cyst for an endometrioma. Therefore, any diagnostic technique that could differentiate accurately and reliably between hemorrhagic cyst, cystadenoma, dermoid cyst, ovarian malignancy, and endometrioma would be a useful additional tool for better management of this enigmatic desease. We prospectively investigated the role of transvaginal color and pulsed Doppler examination in differentiation of ovarian endometriosis from other benign and malignant pelvic lesions in three years period. Therefore, we evaluated morphological and combined scoring system for prediction of ovarian endometriosis.
887 patients with adnexal masses were included in the study. 451 of them were operated by laparatomy, and 436 by laparoscopy. The patients were between 18 and 78 years (mean age 47 years), 98 (11.5%) of them were postmenopausal. 196 endometriomas were histopathologically proved. The criteria inroled in combined noninvasive scoring system were patients age, clinical presentation, serum CA-125 levels, ultrasound finding, and parameters of color and pulsed Doppler. The finding was combined with intraoperative diagnosis, while histopathological finding was considered final.
Ovarian endometriomas appeared as thick-walled cystic structures containing marked internal echoes in 163 (83.16%) patients, multiocular cysts in 13 (6.63%) patients, solid-cystic appearance was present in 19 (9.69%) patients. The median diameter of the endometrioma was 55.3 mm (range 18 to 160 mm). Bilateral changes were detected ultrasonically and proved surgically in 76.53% of cases. Morphological scoring system was 90.72% sensitive, 97.11% specific with a positive predictive value of 89.45% and negative predictive value of 97.41%. Combined scoring system had sensitivity and specificity 99.70 and 98.97% respectivelly, and positive and negative predictive vlue were 98.47% and 98.82% respectivelly.
The combined scoring system based on transvaginal color and pulsed Doppler examination is sensitive and specific method in differentiation of ovarian endometriomas from other benign and malignant lesions of female genital tract.
Sveučilište u Zagrebu, Medicinski fakultet, Zagreb, 1996
Bibliografija: str. 109-137
Sažetak
Keywords: Endometrioza -- Ultrazvučna dijagnostika