Accuracy of hysteroscopic examination in intrauterine pathology: a Brazilian experience

Abstract

OBJECTIVE: To evaluate the accuracy of hysteroscopic view in the diagnosis of intrauterine pathology. DESIGN: Retrospective study of surgical records of all patients who underwent hysteroscopic surgery from July 1997 to June 2004 at Biocor hospital. MATERIALS AND METHODS: Nine hundred and eighty-three consecutive patients who underwent hysteroscopic examination with conclusive histologic results were included. The study was approved by the local Institutional Review Board. Standard histopathological criteria was the gold standard against which the hysterosocpic view was compared. Hysteroscopic diagnosis was defined by the appearance of the surface of the uterine cavity before biopsy or surgery and then matched to histopathology to evaluate accuracy. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and likelihood ratios (LR) were calculated using the Statistical Package for Social Sciences. RESULTS: Mean patient age was 51 years (51±13.5) and the majority (48%) was older than 51 years of age. The most frequent surgical indications were endometrial polyps (44%), abnormal uterine bleeding (29%) and abnormal endometrium on ultrasound (10%). Polypectomy (48%), endometrial biopsy (15%) and polypectomy with endometrial biopsy (14%) were the most frequent surgeries performed. Endometrial polyps (57%) and myomas (10%) were the most frequent diagnosis made by hysteroscopy and histopathologic study (51% and 10% respectively). For endometrial polyps the sensitivity was 93.9% (95%CI 92-96.2), specificity 81.4% (95%CI 77.9-84.9), PPV 83.87(95%CI 80.8-86.9) and NPV 92.9%(95%CI 90.5-100). For myomas sensitivity was 96.8% (95%CI 93.8-100) and specificity 98.9%(95%CI 98.3-99.6), PPV 91.2%(95%CI 85.7-96.7) and NPV 99.7%(95%CI 99.7-100). For endometrial cancer sensitivity was 71.4%(95%CI 47.7-95.1) and specificity 99.9%(95%CI 99.7-100), PPV 90.9%(95%CI 73.9-100) and NPV 99.6%(95%CI 99.2-100). As for simple endometrial hyperplasia sensitivity was 44.4%(95%CI 28.2-60.7) and specificity 97%(95%CI 98.1-99.5), PPV 57.2%(95%CI 38.8-75.5) and NPV 97.9%(95%CI 97-100). Positive LR for polyps (5.0 95%CI 4.1-6.1) was moderate and high for myomas (95.4), endometrial hyperplasia (35.0) and cancer (692.1). CONCLUSIONS: Hysteroscopy appears to be an accurate method to distinguish between normal and abnormal endometrium and can reliably identify endometrial polyps and myomas but cannot safely diagnose or exclude endometrial hyperplasias and cancer. Thus histopathologic should always be performed.