Accuracy of Hysteroscopic View in the Diagnosis of Intrauterine Pathology: A Brazilian Experience

Abstract

Objective: The aim of this study was to evaluate the accuracy of hysteroscopic view in the diagnosis of intrauterine pathology. Design: This work was a retrospective study (Canadian Task Force classification II-3). Materials and Methods: Our retrospective study included 983 consecutive patients who underwent hysteroscopic surgery with conclusive histologic results from July 1997 to June 2004. Standard histopathologic criteria were the gold standard against which the hysteroscopic view was compared to evaluate accuracy. Sensitivity, specificity, and predictive values, as well as likelihood ratios and kappa index, were calculated. Results: Mean patient age was 51 ± 13.51 years, and the main surgical indications were endometrial polyps (44%) and abnormal uterine bleeding (29%). Likelihood ratios showed hysteroscopy was accurate in the diagnosis of benign submucous myomas, endometrial polyps, and cancer. Diagnostic performance was low for endometrial hyperplasia. The kappa index showed substantial agreement between hysteroscopy and histology for endometrial polyps (κ = 0.76), myomas (κ = 0.93), and endometrial cancer (κ = 0.75), but it was moderate for hyperplasia (κ = 0.43). Conclusions: Hysteroscopic view cannot accurately replace histopathologic study in patients with endometrial abnormalities. (J GYNECOL SURG 26:23)