Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta‐analysis

Abstract

Background This study was conducted to assess the accuracy and feasibility of diagnostic hysteroscopy in the evaluation of intrauterine abnormalities in women with abnormal uterine bleeding.Search strategy Electronic databases were searched from 1 January 1965 to 1 January 2006 without language selection. The medical subject heading (MeSH) and textwords for the following terms were used: hysteroscopy, diagnosis, histology, histopathology, hysterectomy, biopsy, sensitivity and specificity.Setting University Hospital.Selection criteria The inclusion criteria were report on accuracy of diagnostic hysteroscopy in women with abnormal uterine bleeding compared to histology collected with guided biopsy during hysteroscopy, operative hysteroscopy or hysterectomy.Data collection and analysis Electronic databases were searched for relevant studies and references were cross-checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated and data were pooled. Subgroup analysis was performed according to validity criteria, study quality, menopausal state, time, setting and performance of the procedure. The pooled sensitivity, specificity, likelihood ratios, post-test probabilities and feasibility of diagnostic hysteroscopy on the prediction of uterine cavity abnormalities. Post-test probabilities were derived from the likelihood ratios and prevalence of intrauterine abnormalities among included studies. Feasibility included technical success rate and complication rate.Main results One population of homogeneous data could be identified, consisting of patients with postmenopausal bleeding. In this subgroup the positive and negative likelihood ratios were 7.9 (95% CI 4.79-13.10) and 0.04 (95% CI 0.02-0.09), raising the pretest probability from 0.61 to a post-test probability of 0.93 (95% CI 0.88-0.95) for positive results and reducing it to 0.06 (95% CI 0.03-0.13) for negative results. The pooled likelihood ratios of all studies included, calculated with the random effects model, were 6.5 (95% CI 4.1-10.4) and 0.08 (95% CI 0.07-0.10), changing the pre-test probability of 0.46 to post-test probabilities of 0.85 (95% CI 0.78-0.90) and 0.07 (0.06-0.08) for positive and negative results respectively. Subgroup analyses gave similar results. The overall success rate of diagnostic hysteroscopy was estimated at 96.9% (SD 5.2%, range 83-100%).Conclusions This systematic review and meta-analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities.

Hysteroscopy—A Mode of Screening Women with Postmenopausal Bleeding: Our Experience

“…[3][4][5][6][7] In our study, women in their 50s formed a major group (i.e. 56.6%) among the subjects with postmenopausal bleeding.…”

Eficiencia De Los Métodos Diagnósticos en El Estudio Del Sangrado Uterino Anormal en La Peri Y Postmenopausia

“…Desde que hubo un estudio demostrando que la histeroscopia es mejor que la D&C en el diagnóstico de pacientes con sangrado uterino anormal (16), los ginecólogos han considerado que este es el mejor método para la evaluación de pacientes con este síntoma. Estos buenos resultados han sido confirmados por posteriores estudios los cuales han demostrado sensibilidades de 96% para el diagnóstico de hiperplasia endometrial y de 92% para el diagnóstico de pólipos (17,18). Sin embargo, algunos investigadores consideran que la histeroscopía tendría poco valor en la detección de lesiones difusas, tales como cáncer o hiperplasia endometrial (11,15).…”

Study of hysteroscopic evaluation in patients with abnormal uterine bleeding

“…7 Though the ultimate gold standard in uterine cavity evaluation is hysterectomy, it cannot be used as a diagnostic tool. 8 Instead of that, Hysteroscopy can be used as a diagnostic tool as it permits direct visualisation of the cervical canal and uterine cavity, enabling observation of intrauterine abnormalities. This safe procedure will lead to more accurate diagnosis and specific surgical or medical treatment directed at the specific pathology and will avoid the need for major surgery.…”