Hallazgos histeroscópicos en mujeres asintomáticas con ecografía sugestiva de patología endometrial

Abstract

Objective The main objective of this study was to determine the prevalence of atypical hyperplasia and endometrial adenocarcinoma detected by hysteroscopy in asymptomatic postmenopausal women with vaginal ultrasonographic findings suggestive of endometrial disease. The second aim was to ascertain the usefulness of hysteroscopy in the diagnosis of premalignant and malignant lesions in these patients. Subjects and methods We performed a descriptive study of 1,237 hysteroscopies carried out over a 7-year period (January 2000 to December 2006) in the Gynecology Department of Hospital Donostia. All the women were asymptomatic and were referred to our clinic due to an ultrasound examination suggestive of endometrial disease. Results The most frequent hysteroscopic findings were endometrial polyps (64.3%), followed by a diagnosis of normality (15.7%). A total of 1,046 endometrial biopsies were performed. In addition, 27 patients underwent hysterectomy; 14 were diagnosed with atypical hyperplasia (1.13%) and 20 with stage I endometrial adenocarcinoma (1.61%). The specificity and negative predictive value of hysteroscopy in the diagnosis of premalignant and malignant lesions were high (specificity: 97.5%, negative predictive value 99.6%, positive likelihood ratio 31.25). Conclusions The results of our study suggest that the efficiency of transvaginal ultrasound screening in asymptomatic menopausal women in the diagnosis of premalignant and malignant endometrial disease is not high. Hysteroscopy allows a reliable diagnosis in this group of women.