Study of hysteroscopic evaluation in patients with abnormal uterine bleeding

Abstract

Background: Abnormal uterine bleeding in women is the commonest presenting complaint which accounts for one third of all gynecological consultations. It not only causes discomfort, inconvenience to healthy women but also affects their quality of life and impose financial burden on them. This insists the physician to diagnose its etiology and provide appropriate treatment. Hysteroscopy guided biopsy is a simple, safe, reliable procedure in the diagnosis of abnormal uterine bleeding. The objective of the study was to evaluate the uterine pathology in premenopausal women with abnormal uterine bleeding by hysteroscopy.Methods: This prospective study was conducted at ESIC-MC and PGIMSR, Rajajinagar, Bangalore, in 50 premenopausal women with abnormal uterine bleeding over 18 months from Dec 2012 to May 2014. All 50 women were subjected to diagnostic hysteroscopy followed by curettage. The sample was sent to histopathological examination. Data was collected and analyzed.Results: In the present study, abnormal uterine bleeding was more common in 41-45yrs of age. The commonest presenting complaint was heavy menstrual bleeding (menorrhagia) in 54% of cases. The abnormal findings on hysteroscopy were: Hyperplasia 42%, endometrial polyp 22%, sub-mucous myoma 4%, carcinoma endometrium 2%, synechiae 2% and endometritis 2%. Negative hysteroscopic view was seen in 26%. The sensitivity, specificity, positive and negative predictive value of hysteroscopy was 91.89%, 92.31%, 97.14% and 80% respectively. The overall diagnostic accuracy of hysteroscopy was 92%.Conclusions: Hysteroscopy and its directed biopsy renders high diagnostic accuracy in patients with abnormal uterine bleeding and thereby guiding them for further management.

An analytical study of hysteroscopic evaluation in patients with abnormal uterine bleeding, and its correlation with histopathology

“…A study conducted by Kathuria R et al 19 in 2014 showed results that are almost identical to ours: 40% of patients exhibited abnormalities, while 60% had normal HPE reports. According to a study by Patil SG et al 10 in 2009, proliferative phase endometrium was found to be the most common finding, which contrasts with the results of our study, where secretory endometrium was the most frequently reported histopathology. In the study of Bashir H et al 20 (2015) endometrial hyperplasia was found in 18.9% of cases, which was also concordant with observations made by Patil SG et al 10 (2009) reported 20.0% of patients had endometrial hyperplasia, but higher than that observed by Doraiswami S et al 21 (2011) in 6.11% patients and Abid M et al 22 (2014) reported endometrial hyperplasia in 5.0% patients.…”

“…Furthermore, the prevalence of endometrial hyperplasia peaks among perimenopausal and postmenopausal women. 10 Overall comparison of validities of Hysteroscopy and Histopathology On hysteroscopy, the overall sensitivity, specificity, positive predictive value, and negative predictive value were as follows 96.15%, 86.49% 83.33%, and 96.97% respectively. On histopathology, the overall sensitivity, specificity, positive predictive value, and negative predictive value were as follows 80%, 72.73% 92.31%, and 84.21% respectively.…”

“…However, this method is less sensitive for obtaining a definitive diagnosis, with a diagnostic error rate ranging from 10.0 to 25.0%. 10 The medical procedure known as dilatation and curettage (D&C) is typically performed without direct visualization, meaning that the doctor cannot see the inside of the uterus during the procedure, This indicates that in approximately 60.0% of patients, the device is capable of scraping less than 50.0% of the endometrial cavity. Consequently, its diagnostic accuracy in identifying structural pathologies such as polyps, fibroids, intrauterine adhesions, and congenital malformations is lower compared to hysteroscopy.…”