Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

Abstract

CONTEXT AND OBJECTIVES: Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. DESIGN AND SETTING: Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. RESULTS: There were 510 patients, with a mean age of 61.1 ± 2.0 years and mean time elapsed since the menopause of 12.7 ± 2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. CONCLUSIONS: Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.

Office Hysteroscopy After Ultrasonographic Diagnosis of Thickened Endometrium in Postmenopausal Patients

“…Ribeiro et al [12] reported only one carcinoma (0.25%) in 399 asymptomatic patients who underwent hysteroscopy and questioned the utility of ultrasound among asymptomatic women. Our experience, on the other hand, favors sonographic screening in these women since we found higher rates of carcinoma and endometrial hyperplasia (2.9% and 3.5%, respectively).…”

The role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation following blind dilatation and curettage

“…The incidence of endometrial cancer that is seen in the literature is generally higher. 31 Abnormal peri and postmenopausal bleeding is associated with endometrial cancer in about 10% of cases. 32 The lower incidence in our study was may be due to the patients with postmenopausal bleeding were taken up for fractional curettage, which is still opted by many of the gynecologists in our setup.…”

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

“…This data was supported by many studies. 2,8 It is apparent that hysteroscopy is much more sensitive than TVS in the detection of focal endometrial pathology, and the specificity of hysteroscopy is more than TVS in diagnosing various endometrial conditions (98.5 and 93.3% respectively) ( Table 5).…”