Flexible outpatient hysteroscopy without anaesthesia: a safe, successful and well tolerated procedure

Kremer, Christian; Barik, Sukumar; Duffy, Sean

doi:10.1111/j.1471-0528.1998.tb10185.x

Cited by 65 publications

(50 citation statements)

References 17 publications

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“…39 We found a hysteroscopic diagnosis of polyps in 33.2% of asymptomatic postmenopausal ER-positive women, and higher than that reported in 2009 by Dreisler et al, 30 who found polyps in 13% (22/169) of asymptomatic postmenopausal 19,35,40,41 found a much lower incidence of endometrial polyps, and we believe that this is so because they did not perform hysteroscopy on patients with an endometrial thickness of less than 4 mm and their patients were younger and less obese than those in our study. In 35 of 40 (87.5%) hysteroscopic diagnoses of endometrial polyps in our postmenopausal women, diagnosis was histologically confirmed, representing an acceptable rate of falsepositive findings on hysteroscopic screening.…”

Section: Discussionmentioning

confidence: 48%

Baseline hysteroscopic assessment of endometrium in asymptomatic postmenopausal women with estrogen receptor–positive breast cancer

et al. 2013

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Section: Discussionmentioning

confidence: 48%

Baseline hysteroscopic assessment of endometrium in asymptomatic postmenopausal women with estrogen receptor–positive breast cancer

et al. 2013

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“…The use of local anaesthesia, with intracervical or paracervical block, in hysteroscopy has been studied extensively, with little evidence of reduction in pain. Our standard procedure using no anaesthesia has been shown to be successful and well tolerated 10,11 , with a mean pain score of 2.3 in these studies. This level has increased slightly in the present study, possibly as a result of the greater proportion of postmenopausal women investigated, with a mean pain score of 3.6 for hysteroscopy and a lower score of 2.5 for saline infusion hysterosonography.…”

Section: Discussionmentioning

confidence: 72%

“…The transvaginal probe and catheter were then removed and a visual analogue pain score was performed. The speculum was replaced and a 3.1-mm flexible hysteroscope (KeyMed Olympus, UK) was inserted, observing the uterine cavity on a high-resolution colour monitor using a single-chip camera 10,11 . Saline was used as the distension medium, with both tubal ostia being noted and the endometrial appearances documented.…”

Section: Methodsmentioning

confidence: 99%

A comparison of outpatient hysteroscopy with saline infusion hysterosonography

Rogerson¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy. Design Prospective, parallel, blinded comparative study.Setting Outpatient hysteroscopy clinic in a large university teaching hospital.Population All women referred for outpatient hysteroscopy in a 15-month period.Interventions Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result. Main outcome measures The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test. Results One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy. Conclusions Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.

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“…Kremer et al 22 and Nagele et al 24 found a higher incidence of polyps and fibroids. La Sala et al 23 found a similar incidence of polyps and fibroids in patients with postmenopausal bleeding.…”

Section: Discussionmentioning

confidence: 95%

The ATAC adjuvant breast cancer trial in postmenopausal women: baseline endometrial subprotocol data

Duffy¹

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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On behalf of The ATAC Trialists' GroupObjective The ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial is a randomised, double-blind trial comparing 'Arimidex' (anastrozole), alone or in combination with tamoxifen, relative to tamoxifen alone as a five year adjuvant treatment for postmenopausal women with early breast cancer. Because tamoxifen is associated with endometrial pathology, the ATAC endometrial subprotocol was initiated to establish the background prevalence of pathology, and to assess prospectively the incidence and nature of intrauterine changes before and following endocrine therapy. Setting International.Population and Study Design Two hundred and eighty-five women entered the subprotocol: the mean age was 60 years (range 44-80 years); 113 women (40%) had taken hormone replacement therapy prior to randomisation, and 238 women were parous (84%). The age at onset of the menopause was 32-58 years, with the majority becoming menopausal between 46 and 55 years of age. Two hundred and seventy-two women had a hysteroscopy before they commenced trial medication. Hysteroscopy was performed successfully in 265 women. In six women, failure of hysteroscopy at baseline led to withdrawal from the study. Three of the women who withdrew had a pipelle biopsy taken. Therefore, the total number of endometrial biopsies at baseline was 268. Main outcome measures To assess the demographic characteristics of women entering the endometrial subprotocol and their hysteroscopic and histological findings before commencing trial medication. Results At hysteroscopy, there was a diagnosis of endometrial polyps in 34 women (13%), fibroids in 16 women (6%) and one case of suspicious endometrium, which was confirmed as a polyp on histology. Only 21 of the 34 polyps seen hysteroscopically were proven histologically (62% accuracy of hysteroscopy).Final histology found the prevalence of endometrial diagnostic categories as follows: 123 inactive endometrium (46%), 20 benign polyps (7%), 17 secretory endometrium (6%), 7 proliferative endometrium (3%), 3 atypical hyperplasia (2 in a polyp), 1 simple hyperplasia (in a polyp) and 1 fibroid. The remaining women had pipelle samples with insufficient tissue obtained, indicating a normal endometrial cavity. Conclusion This is the first study of such size in gynaecologically asymptomatic breast cancer patients. This paper describes the findings in individual patients before any trial treatment was given. In this baseline group, 82% (219/268) of women had a normal endometrial cavity; 18% (49/268) had endometrial activity (proliferative or secretory endometrium in 9%) or an intracavity abnormality (hyperplasia, polyps and a fibroid in 9%). In total, 36% of biopsies had insufficient tissue for diagnosis, which in combination with a normal hysteroscopy was classed as normal. The appearance of a polyp hysteroscopically in this group was not proven histologically in approximately 40% of cases. The development of uterine pathology over time in the ATAC study will subsequently be assessed again...

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Flexible outpatient hysteroscopy without anaesthesia: a safe, successful and well tolerated procedure

Cited by 65 publications

References 17 publications

Baseline hysteroscopic assessment of endometrium in asymptomatic postmenopausal women with estrogen receptor–positive breast cancer

Baseline hysteroscopic assessment of endometrium in asymptomatic postmenopausal women with estrogen receptor–positive breast cancer

A comparison of outpatient hysteroscopy with saline infusion hysterosonography

The ATAC adjuvant breast cancer trial in postmenopausal women: baseline endometrial subprotocol data

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