182: Mini-Hysteroscopy Findings in Women Complaining of AUB and with No Abnormality at TVE

Abstract

Abnormal uterine bleeding (AUB) is the most frequent indication for specialist consultations worldwide. Transvaginal echography (TVE) and SHG are considered first line diagnostic investigation in patients with AUB. This study aimed at evaluating the value of fluid mini-hysteroscopy (MiniHys) in women in whom TVE found no abnormality. We therefore compared findings at MiniHys with that at histology, endocervical and endometrial cultures in a group of women complaining of AUB and with no evidence of pathology at TVE. Prospective study. Clinical research and academic environment. Hundred pre-menopausal patients (age range 20–46 yrs) complaining of AUB with normal uterine cavity on TVE performed in the mid proliferative phase. Women in their follicular phase underwent diagnostic fluid MiniHys using speculum, endocervical swabs and endometrial biopsy. Main outcome measures: Endometrial findings at hysteroscopy, endometrial histology, endocervical and endometrial cultures (common bacteria, mycoplasma, chlamidya). At hysteroscopy 21 cases of endocervical polyps and 12 cases of endometrial polyps were detected. All endometrial polyps were smaller than 0.5 cm. However, in 71 cases hysteroscopic signs of chronic endometritis and/or endocervicitis were found. More in detail, hyperhemia, easy bleeding, mucosal adhesions, isolated or diffuse micropolyps, stromal edema were considered as sign of inflammation. Histology confirmed the diagnosis of CE in 40 (56.3%) cases; accordingly, endometrial culture was positive in 44 (62.0%) cases whereas positive cases at endocervical culture were significantly lower (n=29, 40.8%) (Fisher exact test: P<0.05 and P<0.01, vs. histology and endometrial culture, respectively). In 29 women with no signs of CE at MiniHys histology was positive in only 1 case, endometrial and endocervical cultures in 2 and 5 cases, respectively. In about two-thirds of women complaining of AUB but with no evidence of abnormality at TVE, direct inspection of endometrial cavity by means of hysteroscopy demonstrated signs of CE. Results of histology and endometrial cultures but not endocervical cultures showed high concordance and confirmed the hysteroscopic diagnosis in about 60% of cases. The nature of remaining 40% of cases of hysteroscopic CE remains unknown. On the basis of these results and of the advantages of MiniHys with respect to conventional hysteroscopy, MiniHys should be performed in all patients complaining of AUB whatever is TVE and SHG result.