Abstract
Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. There were 510 patients, with a mean age of 61.1+/-2.0 years and mean time elapsed since the menopause of 12.7+/-2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.
Highlights
Endometrial cancer, the most prevalent type of malignant neoplasia of the genital tract in Western countries,[1] presents the best prognosis, since approximately 70% of the cases are detected in their early stages.[2]
Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%
The secondary objective was to determine the mean thicknesses of benign lesions of the endometrial cavity, comparing them to those found in cases of endometrial carcinoma and endometrial hyperplasia
Summary
Endometrial cancer, the most prevalent type of malignant neoplasia of the genital tract in Western countries,[1] presents the best prognosis, since approximately 70% of the cases are detected in their early stages.[2] Between 80 and 95% of such patients present vaginal bleeding as the first symptom,[3] enabling prompt diagnosis and therapeutic intervention. Since vaginal bleeding is a common symptom among postmenopausal women, ultrasound has been a useful screening method for determining which symptomatic patients should undergo invasive collection of endometrial samples. In this situation, endometrial thickening, as measured by ultrasonography, correlates better with the presence of endometrial lesions[9,10,11] than among asymptomatic women
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