DIAGNOSTIC HYSTEROSCOPY IN ABNORMAL UTERINE BLEEDING & IT'S HISTOPATHOLOGIC CORRELATION: OUR EXPERIENCE

Abstract

Aims & objectives: 1) To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding in perimenopausal and postmenopausal women. 2) To correlate hysteroscopic findings with histopathologic results. Materials and methods: It is a retrospective study done in the department of OBG at K. S.Hegde Medical Academy, Mangalore. All patients who underwent diagnostic hysteroscopy for abnormal uterine bleeding in the past 6 years were included in this study. Patients underwent clinical and sonographical evaluation. Following hysteroscopic evaluation, patients had undergone dilatation and curettage and endometrial curetting were sent for histopathological examination (HPE). The correlation between findings on hysteroscopy & HPE were tabulated. Results: On hysteroscopy, endometrium was classified as suggestive of normal, hyperplasia, atrophic, polyp, fibroid, cancer. Histopathological diagnosis was taken as gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. Out of 175 patients, 108 patients were diagnosed to have endometrial hyperplasia on hysteroscopy, however only 53 confirmed to have on histopathologically. Similarly 25 patients were said to have normal findings on hysteroscopy but by histopathology 85 were having normal endometrium. Hysteroscopy was highly specific for diagnosis of polyp (95.9%), cancer (100.0%), and atrophy (96. 9%), normal endometrium (92.2%) but low specificity for diagnosing hyperplasia (48.4%). The sensitivity of hysteroscopy in diagnosing polyp and endometrial hyperplasia were 100% and 84.9% respectively but it was low in case of cancer (16.7%) and normal endometrium (21.2%). Conclusion: Hysteroscopy is a highly accurate diagnostic tool in diagnosing intrauterine lesions like endometrial polyp and submucous fibroid. In fact, it was also found to be highly specific in conditions like endometrial cancer, polyp, atrophic and normal endometrium.

Hysteroscopy: a boon in abnormal uterine bleeding

“…Endometrial cancer is a rare finding in AUB cases with only few studies reporting its prevalence in the range of 1.7-4.1%. 11,12 In present study, on histopathology, 56 (65.11%) cases were shown to have normal/proliferative/atrophic endometrium, 17 (19.76%) had hyperplasia, 3 (3.48%) had calcified endometrium, and 10 (11.62%) had polyp. Similarly, Patil et al 13 also showed the absence of abnormal pathologies in 67% of their patients.…”

Use of Hysteroscopy in Abnormal Uterine Bleeding: An Edge Over Histopathological Examination

“…Contrary to findings in present study, Chaudhari and Sathe [17] in their study reported a very high sensitivity and specificity of hysteroscopy for detection of abnormalities (98.3 and 80.5%, respectively). In yet another study, Nandan et al [11] found hysteroscopy to be highly sensitive 92.2% but poorly specific 21.2% in detection of abnormal pathologies when compared to histopathology.…”

“…These findings are in accordance with the observations of a number of other studies that did not report a single case of endometrial carcinoma in their series. Endometrial cancer is a rare finding in AUB cases with only few studies reporting its prevalence in the range of 1.7-4.1% [11,12].…”

Role of hysteroscopy in evaluation of patients with abnormal uterine bleeding

“…100% correlation of hysteroscopy and histopathology was noted with simple hyperplasia, Submucousmyoma, Endometrial polyp and cystoglandular hyperplasia. A similar study from Mangalore by Nandan N et al [7] . (2013) also reported correlation between hysteroscopy findings and histopathological examination of endometrial curetting.…”