Endometrial Polipi Ayırt Etmede İnflamatuar Belirteçlerin Rolü: Tek Merkez Sonuçları

Year 2024, Volume: 6 Issue: 4, 131 - 136, 06.11.2024

Büşra Şahin , Elif Yaman , Fatma Nur Düzenli , Fatih Davran

https://doi.org/10.46969/EZH.1538701

Abstract

Amaç: Anormal uterin kanama nedeniyle endometrial örnekleme yapılan hastalarda endometrial polip varlığını öngörmede inflamatuar belirteçlerin rolünü değerlendirmek.
Yöntem: Mayıs 2023- Temmuz 2023 tarihleri arasında Akçakoca Devlet Hastanesine anormal uterin kanama ile başvuran ve endometriyal örnekleme yapılan hastaların patoloji sonuçları retrospektif olarak tarandı. Hastaların demografik özellikleri, Trombosit-lenfosit, nötrofil-lenfosit ve lenfosit-monosit oranları, sistemik immün inflamasyon indeksi hesaplandı. Hastalar patolojik tanıya göre endometrial polip ve diğer bening patolojiler olmak üzere gruplandırıldı. Malign ve premalign lezyonlar çalışmaya dahil edilmedi. Tetkik sonuçları ve inflamatuar belirteçler bu iki grup arasında karşılaştırıldı.
Bulgular: Çalışmaya 89 hasta dahil edildi. 38 hastanın patoloji sonucu endometrial polip iken 51 hastada diğer bening patolojiler saptandı. Endometrial polip olan hastalarda hemoglobin, hemotokrit, lenfosit, monosit, platelet, nötrofil ve PDW değişkenleri açısından anlamlı bir fark saptanmadı (p>0,05). PLR (trombosit-lenfosit oranı) ve SII (sistemik immün-inflamatuar indeks) endometial polip grubunda diğer bening patolojilere göre anlamlı olarak daha yüksek bulundu ( p<0,05). NLR (nötrofil-lenfosit oranı) endometrial polip grubunda daha yüksek olup anlamlı değildi (p: 0,056). SII endometrial polip grubunda 669884,4±410641,7 olup diğer bening patolojilere göre daha yüksekti (p<0,05).
Sonuç: Endometrial polip anormal uterin kanamanın önemli sebeplerinden biridir. NLR, PLR ve SII ek bir maliyet gerektirmeksizin kan testleri ile kolayca değerlendirilebilen sistemik immün yanıt parametreleridir. SII bening endometrial patolojiler arasında endometrial polipi ayırt etmede etkili ve basit bir tetkik olarak görünmektedir.

Keywords

Anormal uterin kanama, Endometrial polip, sistemik immün-inflamatuar indeks

The Role of Inflammatory Markers in Distinguishing Endometrial Polyp: Single Center Results

Abstract

Objective: To investigate the role of inflammatory markers in predicting the presence of endometrial polyps in patients undergoing endometrial sampling due to abnormal uterine bleeding.
Methods: The pathology results of patients who presented to Akçakoca State Hospital with abnormal uterine bleeding and underwent endometrial sampling between May 2023 and July 2023 were retrospectively examined. The demographic characteristics of the patients, platelet-lymphocyte, neutrophil-lymphocyte and lymphocyte-monocyte ratios and systemic immune inflammation index were calculated. Patients were categorized into endometrial polyps and other benign pathologies according to the pathological diagnosis. Malignant and premalignant lesions were not included in the study. The examination results and inflammatory markers were compared between these two groups.
Results: 89 patients were included in the study. While the pathological finding in 38 patients was an endometrial polyp, other benign pathologies were found in 51 patients. No significant difference was found in terms of hemoglobin, hematocrit, lymphocytes, monocytes, platelets, neutrophils and PDW variables in patients with endometrial polyps (p>0.05). PLR (platelet-to-lymphocyte ratio) and SII (systemic immune-inflammatory index) were significantly higher in the endometrial polyp group compared to other benign pathologies (p<0.05). NLR (neutrophil to lymphocyte ratio) was higher in the endometrial polyp group and was not significant (p: 0.056). SII was 669884.4±410641.7 in the endometrial polyp group and was higher than other benign pathologies. (p<0.05)
Conclusion: Endometrial polyps are one of the most important causes of abnormal uterine bleeding. NLR, PLR and SII are parameters of the systemic immune response that can be easily determined with blood tests at no additional cost. SII appears to be an effective and simple test to differentiate endometrial polyps from benign endometrial pathologies.

Keywords

Abnormal uterine bleeding, Endometrial polyps, Systemic immune-inflammatory index

References

• Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2019;144(2):237. https://doi.org/10.1002/ijgo.12709
• Mutter GL, Nucci, MR, Robboy SJ. Endometritis, metaplasias, polyps, and miscellaneous changes. In: Robby SJ, Mutter GL, Prat J, et al., editors. Robboy's Pathology of the Female Reproductie Tract. 2nd ed. Churchill Livingston Elsevier, Oxford; 2009: 34.
• Kim KR, Peng R, Ro JY, Robboy SJ. A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium. Am J Surg Pathol. 2004;28(8):1057-62. https://doi.org/10.1097/01.pas.0000128659.73944.f3
• Jovanovic AS, Boynton KA, Mutter GL. Uteri of women with endometrial carcinoma contain a histopathological spectrum of monoclonal putative precancers, some with microsatellite instability. Cancer Res. 1996;56(8):1917-21.
• Maia H, Pimentel K, Silva TM, et al. Aromatase and cyclooxygenase-2 expression in endometrial polyps during the menstrual cycle. Gynecol Endocrinol. 2006;22(4):219-24. https://doi.org/10.1080/09513590600585955
• Pal L, Niklaus AL, Kim M, Pollack S, Santoro N. Heterogeneity in endometrial expression of aromatase in polyp-bearing uteri. Hum Reprod. 2008;23(1):80-4. https://doi.org/10.1093/humrep/dem346
• Dal Cin P, Vanni R, Marras S, et al. Four cytogenetic subgroups can be identified in endometrial polyps. Cancer Res. 1995;55(7):1565-8.
• Nogueira AA, Sant'Ana de Almeida EC, Poli Neto OB, Zambelli Ramalho LN, Rosa e Silva JC, Candido dos Reis FJ. Immunohistochemical expression of p63 in endometrial polyps: evidence that a basal cell immunophenotype is maintained. Menopause. 2006;13(5):826-30. https://doi.org/10.1097/01.gme.0000242274.32278.a2
• Sahoo SS, Aguilar M, Xu Y, et al. Endometrial polyps are non-neoplastic but harbor epithelial mutations in endometrial cancer drivers at low allelic frequencies. Mod Pathol. 2022;35(11):1702-12. https://doi.org/10.1038/s41379-022-01124-5
• Lieng M, Istre O, Sandvik L, Qvigstad E. Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: cross-sectional study. J Minim Invasive Gynecol. 2009;16(4):465-71. https://doi.org/10.1016/j.jmig.2009.04.005
• Unal B, Doğan S, Karaveli FŞ, Simşek T, Erdoğan G, Candaner I. Giant Endometrial Polyp in a Postmenopausal Woman without Hormone/Drug Use and Vaginal Bleeding. Case Rep Obstet Gynecol. 2014;2014:518398. https://doi.org/10.1155/2014/518398
• Lieng M. Endometrial polyps. 2015. Available at: http://www.nfog.org/files/guidelines/NFOG_Guideline_NOR_160419%20Endometrial%20polyp%20NO%20merged.pdf
• Zhang H, He X, Tian W, Song X, Zhang H. Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review. J Minim Invasive Gynecol. 2019;26(4):618-27. https://doi.org/10.1016/j.jmig.2018.10.024
• Haque M, Mneimneh W. Endometrial polyp. 2018. Available at: http://www.pathologyoutlines.com/topic/uterusendopolyp.html
• American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19(1):3-10. https://doi.org/10.1016/j.jmig.2011.09.003
• Szeszko Ł, Oszukowski P, Kisiel A, et al. Histopathological results anal- ysis in women undergoing hysteroscopic procedures due to endome- trial polyps. Health Prob Civil. 2019;13:99-103. https://doi.org/10.5114/hpc.2019.81340
• Resta L, Cicinelli E, Lettini T, et al. Possible Inflammatory Origin of Endometrial Polyps. Arch Reprod Med Sexual Health. 2018;1:8-16.
• Goswami B, Rajappa M, Sharma M, Sharma A. Inflammation: its role and interplay in the development of cancer, with special focus on gynecological malignancies. Int J Gynecol Cancer. 2008;18(4):591-9. https://doi.org/10.1111/j.1525-1438.2007.01089.x
• Gitas G, Proppe L, Alkatout I, et al. Accuracy of frozen section at early clinical stage of endometrioid endometrial cancer: a retrospective analysis in Germany. Arch Gynecol Obstet. 2019;300(1):169-74. https://doi.org/10.1007/s00404-019-05158-0
• Gitas G, Ertan K, Rody A, Baum S, Tsolakidis D, Alkatout I. Papillary squamotransitional cell carcinoma of the uterine cervix: a case report and review of the literature. J Med Case Rep. 2019;13(1):319. https://doi.org/10.1186/s13256-019-2217-2
• Singh N, Baby D, Rajguru JP, Patil PB, Thakkannavar SS, Pujari VB. Inflammation and cancer. Ann Afr Med. 2019;18(3):121-6. https://doi.org/10.4103/aam.aam_56_18
• Cummings M, Merone L, Keeble C, et al. Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. Br J Cancer. 2015;113(2):311-20. https://doi.org/10.1038/bjc.2015.200
• Haruma T, Nakamura K, Nishida T, et al. Pre-treatment neutrophil to lymphocyte ratio is a predictor of prognosis in endometrial cancer. Anticancer Res. 2015;35(1):337-43.
• Mleko M, Pitynski K, Pluta E, et al. Role of Systemic Inflammatory Reaction in Female Genital Organ Malignancies - State of the Art. Cancer Manag Res. 2021;13:5491-508. https://doi.org/10.2147/CMAR.S312828
• Cakmak B, Gulucu S, Aliyev N, Ozsoy Z, Nacar M, Koseoglu D. Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia. Obstet Gynecol Sci. 2015;58(2):157-61. https://doi.org/10.5468/ogs.2015.58.2.157
• Lei H, Xu S, Mao X, et al. Systemic Immune-Inflammatory Index as a Predictor of Lymph Node Metastasis in Endometrial Cancer. J Inflamm Res. 2021;14:7131-42. https://doi.org/10.2147/JIR.S345790
• Gökulu ŞG, Aytan P, İlhan TT, et al. Can a complete blood count test predict coexisting adenocarcinoma in patients with atypical endometrial hyperplasia? Journal of Experimental and Clinical Medicine. 2024;41(1):92-6.
• Drizi A, Djokovic D, Laganà AS, van Herendael B. Impaired inflammatory state of the endometrium: a multifaceted approach to endometrial inflammation. Current insights and future directions. Prz Menopauzalny. 2020;19(2):90-100. https://doi.org/10.5114/pm.2020.97863