Diagnostik und Therapie benigner und prämaligner Veränderungen des Endometriums

In der Praxis stellen sich fast 30% der prämenopausalen Frauen und 75% der postmenopausalen Frauen wegen abnormen uterinen Blutungen vor. Diese sind häufig Symptom verschiedener benigner und prämaligner Veränderungen des Endometriums. Anhand aktueller Leitlinien informiert die vorliegende Arbeit über die diagnostischen und therapeutischen Möglichkeiten im Zusammenhang mit Endometriumveränderungen.

Kernaussagen

• Benigne und prämaligne Veränderungen des Endometriums sind häufig; typisches Symptom hierbei ist eine atypische Blutung.

• Die transvaginale Sonografie stellt noch immer den diagnostischen Goldstandard bei Endometriumveränderungen dar.

• Eine diagnostische Hysteroskopie mit fraktionierter Abrasio ist zum Ausschluss einer Malignität erforderlich.

• Mittels operativer Hysteroskopie kann Patientinnen mit Polypen, einfacher Endometriumhyperplasie und Asherman-Syndrom geholfen werden.

Schlüsselwörter

Endometriumveränderungen - Endometriumhyperplasie - Hysteroskopie - Polypen

• Literatur

• 1 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
• 2 Smith-Bindman R, Kerlikowske K, Feldstein VA. et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998; 280: 1510-1517
• 3 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
• 4 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
• 5 Mencaglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med 1987; 32: 577-582
• 6 Griffin Y, Sudigali V, Jacques A. Radiology of benign disorders of menstruation. Semin Ultrasound CT MR 2010; 31: 414-432
• 7 Clark TJ, Voit D, Gupta JK. et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 2002; 288: 1610-1621
• 8 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
• 9 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
• 10 Dijkhuizen FP, Mol BW, Brolmann HA. et al. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89: 1765-1772
• 11 Emons G, Steiner E, Vordermark D. et al. Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Number 032/034-OL, April 2018) – Part 2 with Recommendations on the Therapy and Follow-up of Endometrial Cancer, Palliative Care, Psycho-oncological/Psychosocial Care/Rehabilitation/Patient Information and Healthcare Facilities. Geburtshilfe Frauenheilkd 2018; 78: 1089-1109
• 12 Emons G, Steiner E, Vordermark D. et al. Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Nummer 032/034-OL, April 2018) – Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer. Geburtshilfe Frauenheilkd 2018; 78: 949-971
• 13 Horn LC, Trost M, Bilek K. Staging of endometrial carcinoma: aspects of ovarian and cervical involvement. Int J Gynecol Pathol 2010; 29: 63-66
• 14 Talhouk A, McConechy MK, Leung S. et al. Confirmation of ProMisE: A simple, genomics-based clinical classifier for endometrial cancer. Cancer 2017; 123: 802-813
• 15 Null DB, Weiland CM, Camlibel AR. Postmenopausal bleeding-first steps in the workup. J Fam Pract 2012; 61: 597-604
• 16 Gerber B. Stellenwert der Hysteroskopie und fraktionierten Abrasio in der Abklärung von Postmenopausenblutungen. Geburtshilfe und Frauenheilkunde 1998; 58: 440-445
• 17 Gao WL, Zhang LP, Feng LM. Comparative study of transvaginal ultrasonografic and diagnostic hysteroscopic findings in postmenopausal breast cancer patients treated with tamoxifen. Chin Med J (Engl) 2011; 124: 2335-2339
• 18 Friedler S, Margalioth EJ, Kafka I. et al. Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy-a prospective study. Hum Reprod 1993; 8: 442-444
• 19 Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril 1982; 37: 593-610
• 20 Pace S, Stentella P, Catania R. et al. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol 2003; 30: 26-28
• 21 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
• 22 Ben-Arie A, Goldchmit C, Laviv Y. et al. The malignant potential of endometrial polyps. Eur J Obstet Gynecol Reprod Biol 2004; 115: 206-210
• 23 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
• 24 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
• 25 Nathani F, Clark TJ. Uterine polypectomy in the management of abnormal uterine bleeding: A systematic review. J Minim Invasive Gynecol 2006; 13: 260-268
• 26 Lieng M, Qvigstad E, Sandvik L. et al. Hysteroscopic resection of symptomatic and asymptomatic endometrial polyps. J Minim Invasive Gynecol 2007; 14: 189-194 doi:10.1016/j.jmig.2006.09.018
• 27 Hulka JF, Peterson HA, Phillips JM. et al. Operative hysteroscopy: American Association of Gynecologic Laparoscopistsʼ 1993 membership survey. J Am Assoc Gynecol Laparosc 1995; 2: 131-132
• 28 Horn LC, Schnurrbusch U, Bilek K. et al. Risk of progression in complex and atypical endometrial hyperplasia: clinicopathologic analysis in cases with and without progestogen treatment. Int J Gynecol Cancer 2004; 14: 348-353
• 29 CDCP. Center for Disease Control & Prevention; Update to CDCʼs Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep 2012; 61: 590-594