Clinical Value of Hysteroscopy in Diagnosis and Management of Intrauterine Diseases: A Review of 772 Cases

Abstract

Objective To investigate the clinical value of hysteroscopy in diagnosis and management of intrauterine diseases. Methods A total of 772 out-patient cases who underwent hysteroscopical examinations from September 2007 to August 2008 were enrolled in this retrospective study. Clinical data were made statistical analysis. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Informed consent was obtained from all participants. Results ① A total of 772 women were recruited in the study, and hysteroscopical examinations were successfully conducted in 98.70%(762/772) of them. Ten cases failed the hysteroscopy examination, all of them were premenopause cases. The detection rate of intrauterine diseases were 28.76% for endometrial polyps, 14.64% for intrauterine adhesion, 7.51% for intrauterine devices abnormalities and 6.48% for endometrial hyperplasia and so on. ②Biopsies were taken in 423 women, in which hysteroscopical diagnosis of 339 women were confirmed, the coincidence rate was 80.14%(339/423) between two methods. The sensitivity of hysteroscopy for endometrial polyps, simple endometrial hyperplasia and submucous fibroids were 90.99%, 53.06% and 94.44%, respectively, and the specificity were 86.07%, 98.03% and 98.02%, respectively. The positive predictive value (PPV) were 87.83%, 86.67% and 65.38%, respectively. The sensitivity and PPV of hysteroscopy for endometrial carcinoma were 83.33% and 100.00%, respectively. ③Intrauterine diseases were identified in 615 patients (79.66%), among whom 537 by hysteroscopy with an accordance of 87.32% (537/615) and 402 by ultrasonography with an accordance of 65.37% (402/615). Hysteroscopy was better than ultrasonography in the diagnosis of intrauterine diseases (P<0.05). Occupation diseases in uterine cavity were reported in 401 cases. Of those 339 women were reported in hysteroscopy with the accordance of 84.54%, and 303 women were reported in ultrasonography with the accordance of 75.56% (P<0.05). ④Therapy had been conducted simultaneously in 65.49% of 772 women, with endometrial polpys of 86.49%(192/222), intrauterine devices abnormalities of 100.00%(58/58) and adhesions of 90.14%(128/142). Conclusions Hysteroscopy is a safe, effective and minimally invasive approach in diagnosis and management of intrauterine diseases. It could improve the diagnositic accurary than ultrasonography, also therapy can be conducted simultaneously as well. Hysteroscopy combined with endometrial biopsies might be an optimal choice in diagnosis of intrauterine diseases. Key words: hysteroscopy; hysteroscopical diagnosis; intrauterine diseases; occupational diseases in uterine cavity