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Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium

Archives of Gynecology and Obstetrics volume 285, pages 839–843 (2012)Cite this article

An Erratum to this article was published on 12 December 2014

Abstract

Objectives

The goal of this study was to define the diagnostic value of hysteroscopy in evaluating uterine cavity compared to endometrial biopsy in women presenting with postmenopausal bleeding and thick endometrial mucosa with particular attention to endometrial hyperplasia and carcinoma.

Methods

Eighty-three consecutive women presenting with postmenopausal bleeding and endometrial thickness of 5 mm or more measured by transvaginal ultrasound (TVU) were enrolled in a prospective study between May 2008 and July 2010. They underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopic data was compared with the final diagnosis established by histological examination.

Results

The women’s mean age was 61.2 ± 5.2 years (range 44–80). The most frequent endometrial lesion was endometrial polyps (31.1%). Hyperplastic endometrium was confirmed in 23 (27.8%), only 13 cases were suspected by the hysteroscope. Out of the 14 (16.9%) proven cases of endometrial cancer, only half of the cases were suspected. In benign endometrial lesions, the sensitivity of the hysteroscopic view was 94.7%, specificity was 97.8%, positive (PPV) and negative (NPV) predictive values were 97.3 and 95.7%, respectively. On the other hand, hysteroscopy demonstrated an overall sensitivity, specificity, PPV, and NPV of 56.5, 91.6, 72.2, and 84.6%, respectively, in endometrial hyperplasia, whereas the same parameters for endometrial cancer were 50, 94.2, 63.6, and 90.2%.

Conclusion

Hysteroscopy can be used as the first line diagnostic tool for evaluating the benign endometrial lesions, such as endometrial polyp and submucosal myoma, nonetheless hysteroscopy has poor validity for excluding endometrial hyperplasia and cancer in women presenting with the postmenopausal bleeding and thick endometrium.

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References

  1. Bakour SH, Dwarakanath LS, Kahn KS, Newton JR, Gupta JK (1999) The diagnostic accuracy of ultrasound scan in predicting endometrial hyperplasia and cancer in postmenopausal bleeding. Acta Obstet Gynecol Scand 78:447–451

    PubMed  Article  CAS  Google Scholar 

  2. Sousa R, Silvestre M, Almeida E Sousa L et al (2001) Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding. Acta Obstet Gynecol Scand 80:856–862

    PubMed  CAS  Google Scholar 

  3. Loverro G, Bettochi S, Cormio G, Nicolardi V, Greco P, Vimercati A et al (1999) Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding. Maturitas 33:139–144

    PubMed  Article  CAS  Google Scholar 

  4. Bonilla-Musoles F, Raga F, Osborne NG, Blanes J, Coelho F (1997) Three-dimensional hysterosonography for the study of endometrial tumors: comparison with conventional transvaginal sonography, hysterosalpingography, and hysteroscopy. Gynecol Oncol 65(2):245–252

    PubMed  Article  CAS  Google Scholar 

  5. Alexopoulos ED, Simonis CD, Kidsley S, Fay TN (2000) The value of outpatient hysteroscopy in the management of post-menopausal bleeding: a review of 862 cases. Gynaecol Endosc 9:107–112

    Article  Google Scholar 

  6. Colafranceschi M, Bettocchi S, Mencaglia L, van Herendael J (1996) Missed hysteroscopic detection of uterine carcinoma before endometrial resection: report of three cases. Gynecol Oncol 62:298–300

    PubMed  Article  CAS  Google Scholar 

  7. Lalchandani S, Phillips K (2003) Evaluation of endometrial cavity investigation option. Rev Gynecol Prac 3:165–170

    Article  Google Scholar 

  8. Ben-Yehuda OM, Kim YB, Leuchter RS (1998) Does hysteroscopy improves upon the sensitivity of dilatation and curettage in the diagnosis of endometrial hyperplasia or carcinoma? Gynecol Oncol 68:4–7

    PubMed  Article  CAS  Google Scholar 

  9. Uno LH, Sugimoto O, Carvalho FM, Bagnoli VR, Fonseca AM, Pinotti JA (1995) Morphologic hysteroscopic criteria suggestive of endometrial hyperplasia. Int J Gynecol Obstet 49:35–40

    Article  CAS  Google Scholar 

  10. Lilienfeld DE, Stolley PD (1994) Experimental epidemiology: randomized clinical trials. In: Foundation of epidemiology, vol. 8, 3rd edn. Oxford, Oxford University Press, pp 155–178

    Google Scholar 

  11. Irwig L, Macaskill P, Glasziou P, Fahey M (1995) Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol 48:119–130

    PubMed  Article  CAS  Google Scholar 

  12. Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M et al (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280:1510–1517

    PubMed  Article  CAS  Google Scholar 

  13. NVOG (Dutch Society of Obsterics and Gynaecology) (1997) NVOG-richtlijn Abnormaal vaginaal bloedverlies in de postmenopauze [NVOG Guideline: Abnormal vaginal bleeding during the postmenopause]. NVOG, Utrecht

  14. Nasri MN, Shepherd JH, Setchell ME, Lowe DG, Chard T (1991) The role of vaginal scan in measurement of endometrial thickness in postmenopausal women. Br J Obstet Gynaecol 98(5):470–475

    PubMed  Article  CAS  Google Scholar 

  15. Blumenfeld ML, Turner LP (1996) Role of transvaginal sonography in the evaluation of endometrial hyperplasia and cancer. Clin Obstet Gynecol 39:641–655

    PubMed  Article  CAS  Google Scholar 

  16. Hosana Karinne de Marathaoan Souza Martins e Castello Branco, Daniella de Baptista Depes, Fausto Farah Baracat (2008). Einstein 6(3):287–292

    Google Scholar 

  17. Loizzi V, Bettocchi S, Vimercati A, Ceci O, Rossi C, Marello F et al (2000) Hysteroscopic evaluation of menopausal women with endometrial thickness of 4 mm or more. J Am Assoc Gynecol Laparosc 7(2):191–195

    PubMed  Article  CAS  Google Scholar 

  18. Litta P, Merlin F, Saccardi C, Pozzan C, Sacco G, Fracas M et al (2005) Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas 50(2):117–123

    PubMed  Article  Google Scholar 

  19. Triolo O, Antico F, Palmara V, Benedetto V, Panama S, Nicotina PA (2005) Hysteroscopic findings of endometrial carcinoma. Evaluation of 104 cases. Eur J Gynaecol Oncol 26:434–436

    PubMed  CAS  Google Scholar 

  20. Gebauer G, Hafner A, Siebzehnrübl E, Lang N (2001) Role of hysteroscopy in detection and extraction of endometrial polyps: results of a prospective study. Am J Obstet Gynecol 184(2):59–63

    PubMed  Article  CAS  Google Scholar 

  21. Barati M, Masihi S, Moramezi F (2008) Hysteroscopic view of endometrial hyperplasia. Pak J Med Sci 24(1):65–74

    Google Scholar 

  22. de Wit AC, Vleugels MPH, de Kruif JH (2003) Diagnostic hysteroscopy: a valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma? Eur J Obstet Gynecol Reprod Biol 110:79–82

    PubMed  Article  Google Scholar 

  23. Symonds I (2003) Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer. Rev Gynaecol Pract 3:11–15

    Google Scholar 

  24. Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS (2002) Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. J Am Med Assoc 288(13):1610–1621

    Article  Google Scholar 

  25. Angioni S, Loddo A, Milano F, Piras B, Minerba L, Melis GB (2008) Detection of benign intracavitary lesions in postmenopausal women with abnormal uterine bleeding: a prospective comparative study on outpatient hysteroscopy and blind biopsy. J Minim Invasive Gynecol 15(1):87–91

    PubMed  Article  Google Scholar 

  26. Garuti G, Sambruni I, Colonnelli M, Luerti M (2001) Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women. J Am Assoc Gynecol Laparosc 8(2):207–213

    PubMed  Article  CAS  Google Scholar 

  27. Garuti G, Cellani F, Garzia D, Colonnelli M, Luerti M (2005) Accuracy of hysteroscopic diagnosis of endometrial hyperplasia: a retrospective study of 323 patients. J Minim Invasive Gynecol 12(3):247–253

    PubMed  Article  Google Scholar 

  28. Keith WK, Yuen PM (2000) The role of outpatient diagnostic hysteroscopy in identifying anatomic pathology and histopathology in the endometrial cavity. J Am Assoc Gynecol Laparosc 7(3):381–385

    Article  Google Scholar 

  29. Rokita W, Stanislawska M, Nowak-Markwitz E, Kedzia W et al (2009) Diagnostic hysteroscopy in women with endometrial hyperplasia and endometrial cancer–9 years of experience analysis of 142 cases. Int J Gynecol Obstet 107S2:S93–S396

    Google Scholar 

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Conflicts of interest

We declare that we have no conflict of interest.

Author information

Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Amr K. Elfayomy

  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia

    Amr K. Elfayomy & Fawzia A. Habib

  3. Department of Pathology, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia

    Mohamed A. Alkabalawy

Authors
  1. Amr K. Elfayomy
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  2. Fawzia A. Habib
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  3. Mohamed A. Alkabalawy
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Corresponding author

Correspondence to Amr K. Elfayomy.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00404-014-3570-4.

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Elfayomy, A.K., Habib, F.A. & Alkabalawy, M.A. Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium. Arch Gynecol Obstet 285, 839–843 (2012). https://doi.org/10.1007/s00404-011-2068-6

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  • DOI: https://doi.org/10.1007/s00404-011-2068-6

Keywords

  • Postmenopausal bleeding
  • Diagnostic hysteroscopy
  • Endometrial biopsy
  • Endometrial neoplasia