A Comparison of Visual Findings at Hysteroscopy with Endometrial Biopsy Histology among Women Being Investigated for Postmenopausal Bleeding

Abstract

Between 90-95% of patients diagnosed with endometrial cancer present with postmenopausal bleeding. Hysteroscopy and endometrial biopsy are vital tools in the investigation of women with postmenopausal bleeding. Accurate interpretation of visual findings during hysteroscopy is an important requirement in the diagnosis and management of PMB. We undertook an audit of findings of hysteroscopies performed on women with postmenopausal bleeding and compared with histology report of endometrial biopsy taken during the hysteroscopy. Findings will be used to improve service delivery. A retrospective review was conducted between July 2019 to December 2019. Structured proforma was used for anonymised data collection and entered into an excel spreadsheet of the 2018 version. Descriptive statistical analysis was followed to determine frequencies and percentages. Accuracy of hysteroscopic findings was measured against endometrial biopsy histology report. A total of 133 patients referred for postmenopausal bleeding met the criteria for hysteroscopy and endometrial biopsy. The mean age of the participants was 60 years. The overall accuracy of hysteroscopic visual diagnosis of endometrial pathology was 75.0%. The sensitivity and specificity were 80.0% and 88.0%, while the positive predictive value (PPV) and negative predictive value (NPV) were 66.7%, and 93.8% respectively. Specificity and NPV were 100% and 93.8% for endometrial cancer, which was diagnosed in 7.5% of the patients. In conclusion, we found that compared with histologic diagnosis, three quarter of the women with histology confirmed endometrial pathology were correctly identified during hysteroscopy. Hysteroscopy had a high specificity and negative predictive value in excluding endometrial cancer. There is room for more training and skills enhancement.