Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination.

De Franciscis De Franciscis,Schiattarella Schiattarella,Vitale Vitale,Mosca Mosca,Cobellis Cobellis,Guadagno Guadagno,Colacurci Colacurci,Riemma Riemma,Cianci Cianci

doi:10.3390/diagnostics9040142

De Franciscis De Franciscis, Schiattarella Schiattarella + Show 7 more

Open Access

https://doi.org/10.3390/diagnostics9040142

Copy DOI

Abstract

The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.

Highlights

Hysteroscopy with endometrial biopsy is known to be the gold standard for the diagnosis of malignant and pre-malignant endometrial pathologies and related clinical conditions [1,2].Hysteroscopy allows the direct visualization of the endometrium and, the recognition of small and focal anomalies and their targeted biopsy, as opposed to blind sampling techniques, which showed a remarkable incidence of false negatives, especially in cases of focal lesions [3,4,5].It has been estimated that between 15% and 25% of gynecologists in the United States perform office hysteroscopy and, thanks to an easy-to-improve learning curve, the amount of young and senior operators is still increasing [6]
Considering the whole number of patients, in 58.3% (165/283; p = 0.0001) of the cases, the operators successfully predicted the diagnosis of endometrial hyperplasia; 85.8% (109/127; p = 0.0001) of the hysteroscopic impressions were concordant with histopathology when we discovered a benign disease or a normal endometrium
Adopting the current morphological criteria, we found that the accuracy of hysteroscopy in the diagnosis and the prediction of endometrial hyperplasia is high

Summary

Introduction

Hysteroscopy with endometrial biopsy is known to be the gold standard for the diagnosis of malignant and pre-malignant endometrial pathologies and related clinical conditions [1,2].Hysteroscopy allows the direct visualization of the endometrium and, the recognition of small and focal anomalies and their targeted biopsy, as opposed to blind sampling techniques, which showed a remarkable incidence of false negatives, especially in cases of focal lesions [3,4,5].It has been estimated that between 15% and 25% of gynecologists in the United States perform office hysteroscopy and, thanks to an easy-to-improve learning curve, the amount of young and senior operators is still increasing [6]. Hysteroscopy with endometrial biopsy is known to be the gold standard for the diagnosis of malignant and pre-malignant endometrial pathologies and related clinical conditions [1,2]. Available technologies allow one to perform several diagnostic and operative procedures without the need for anesthesia and without any pain or distress for the patient [11,12]. For this reason, the role of dilatation and curettage to assess intrauterine pathologies and abnormal uterine bleeding tends to be no higher than office hysteroscopy [13]

Objectives

Methods

Discussion

Conclusion