Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding

Abstract

In the article by Towlin et al. (Towlin NA, Gviazda IM, March CM. Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding. Am J Obstet Gynecol 1996;174:1678-82), 149 patients underwent office hysteroscopy for evaluation of abnormal uterine bleeding. Sixty-one patients (40%) were ≤40 years old. As reported, the incidence of serious and life-threatening uterine disorders such as endometrial cancer is rare in this group of patients. 1Emanuel MH Verdel MJ Wamsteker K Lammes FB A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications.Am J Obstet Gynecol. 1995; 172: 547-552Abstract Full Text PDF PubMed Scopus (142) Google Scholar, 2Dijkhuizen FP Brolmann HA Potters AE Bongers MY Heins AP The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities.Obstet Gynecol. 1996; 87: 345-349Crossref PubMed Scopus (150) Google Scholar No case of endometrial cancer was diagnosed in the entire group. The authors performed office hysteroscopies after administration of a 600 mg tablet of ibuprofen 30 minutes before the examination. They performed paracervical block, which takes several minutes after administration to produce a result. In some cases Hegar's dilators were used for dilatation of the cervix. The residents performed hysteroscopy procedures with a 5 mm rigid Storz (Tuttlingen, Germany) hysteroscope under supervision of a faculty member. They used a camera and they viewed the images of the uterine cavity. It is hard to believe the authors' claim that all these steps in performing office hysteroscopy took, on average, <10 minutes. It is even harder to believe that the total time, including preoperative and postoperative time and time for registration and review of the film for this procedure, was still <10 minutes. We are in disagreement with the authors' conclusion that office hysteroscopy is a rapid procedure (compared with vaginal ultrasonography). In our experience the appointment for office hysteroscopy takes an average of 30 minutes, whereas vaginal ultrasonography takes only about 20 minutes. The cost of office hysteroscopy in this series was $350 to $500 more than that of ultrasonography. Today gynecologists are challenged to practice cost-effective, high-quality, outcome-justified diagnostic and therapeutic procedures in the management of women's health problems. In the presence of less costly diagnostic tools such as pelvic ultrasonography, diagnostic hysteroscopy could have been avoided in a large number of these cases.3American College of Obstetricians and Gynecologists Hysteroscopy. The College, Washington1994Google Scholar