Download PDF
Frauenheilkunde up2date 2013; 7(4): 299-317
DOI: 10.1055/s-0032-1325089
Allgemeine Gynäkologie und gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie benigner und prämaligner Veränderungen des Endometriums

Ingolf Juhasz-Böss
,
Russalina Mavrova
,
Gilda Schmidt
,
Erich Franz Solomayer
,
Daniel Herr
Further Information

Publication History

Publication Date:
21 August 2013 (online)

Also available at
    Permissions and Reprints All articles of this category

Updated by:

Diagnostik und Therapie benigner und prämaligner Veränderungen des EndometriumsFrauenheilkunde up2date 2019; 13(06): 511-529
DOI: 10.1055/a-0986-5884

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
    Google Scholar
  • 2 Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding. Radiol Clin North America 2003; 41: 769-780
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Griffin Y, Sudigali V, Jacques A. Radiology of benign disorders of menstruation. Semin Ultrasound CT MR 2010; 31: 414-432
    CrossrefPubMedGoogle Scholar
  • 11 Wieser F, Tempfer C Kurz C,. Hysteroscopy in 2001: a comprehensive review. Acta Obstet Gynecol Scand 2001; 80: 773-783
    CrossrefGoogle Scholar
  • 12 Mencaglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med 1987; 32: 577-582
    PubMedGoogle Scholar
  • 13 Nagele F, OʼConnor H, Davies A et al. 2500 Outpatient diagnostic hysteroscopies. Obstet Gynecol 1996; 88: 87-92
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 15 Cacciatore B, Ramsay T, Lehtovirta P. Transvaginal sonography and hysteroscopy in postmenopausal bleeding. Acta Obstet Gynecol Scand 1994; 73: 413-416
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 24 Lewis BV. Hysteroscopy in gynaecological practice: a review. J Royal Soc Med 1984; 77: 235-237
    Google Scholar
  • 25 Brooks PG, Serden SP. Hysteroscopic findings after unsuccessful dilatation and curettage for abnormal uterine bleeding. Am J Obstet Gynecol 1988; 158: 1354-1357
    Google Scholar
  • 26 Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol 1975; 45: 537-541
    Google Scholar
  • 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
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 31 Newell S, Overton C. Postmenopausal bleeding should be referred urgently. The Practitioner 2012; 256: 13-15
    Google Scholar
  • 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
    Google Scholar
  • 33 Null DB, Weiland CM, Camlibel AR. Postmenopausal bleeding-first steps in the workup. J Fam Pract 2012; 61: 597-604
    Google Scholar
  • 34 Gerber B. Stellenwert der Hysteroskopie und fraktionierten Abrasio in der Abkla¨rung von Postmenopausenblutungen. Geburtsh Frauenheilkd 1998; 58: 440-445
    Article in Thieme ConnectGoogle Scholar
  • 35 Janni W, Rach B, Friese K Hrsg. Facharzt Gynäkologie. München: Elsevier; 2008
    Google Scholar
  • 36 Deligdisch L. Effects of hormone therapy on the endometrium. Mod Pathol 1993; 6: 94-106
    Google Scholar
  • 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
    Google Scholar
  • 38 DeWaay DJ, Syrop CH, Nygaard IE et al. Natural history of uterine polyps and leiomyomata. Obstet Gynecol 2002; 100: 3-7
    CrossrefGoogle Scholar
  • 39 Goldstein SR, Monteagudo A, Popiolek D et al. Evaluation of endometrial polyps. Am J Obstet Gynecol 2002; 186: 669-674
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 41 Reslova T, Tosner J, Resl M et al. Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133-139
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 45 Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2008; 89: 1-16
    CrossrefGoogle Scholar
  • 46 Römer T. Hysteroskopischer Wegweiser für Gynäkologen. 2.. Aufl. Berlin: Walter De Gruyter; 2007
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 49 Gregoriou O, Konidaris S, Vrachnis N et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric 2009; 12: 454-458
    CrossrefGoogle Scholar
  • 50 Berzolla CE, Schnatz PF, OʼSullivan DM et al. Dysplasia and malignancy in endocervical polyps. J Womenʼs Health 2007; 16: 1317-1321
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 53 Diedrich KHW, Jonat W. Gynäkologie und Geburtshilfe. Heidelberg, Berlin: Springer Verlag; 2000: 590-591
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 59 Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril 1982; 37: 593-610
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 61 Pace S, Stentella P, Catania R et al. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol 2003; 30: 26-28
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 63 Denschlag D, Ulrich U, Emons G. The diagnosis and treatment of endometrial cancer: progress and controversies. Dtsch Arzteblatt Int 2011; 108: 571-577
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 68 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. Morb Mortal Wkly Rep 2006; 55: 38-42
    Google Scholar
  • 69 Chin J. Control of Communicable Diseases Manual. Washington: Am Public Health Assoc; 2000: 97-99
    Google Scholar
  • 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
    Google Scholar
  • 71 Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Syst Rev 2002; (3) CD000933
    Google Scholar
  • 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
    Google Scholar