Risk of Discovering Endometrial Carcinoma or Atypical Hyperplasia during Hysteroscopic Surgery in Postmenopausal Women

Abstract

Study ObjectiveTo assess the risk of diagnosing endometrial carcinoma or atypical hyperplasia in tissue resected during hysteroscopy performed for intrauterine pathology presumed benign in postmenopausal women. DesignA single-center prospective study (Canadian Task Force classification II-2). SettingDepartment of Gynecology, La Conception Hospital, Marseille, France. PatientsThree hundred twenty-five women with intrauterine pathology, presumed benign, causing postmenopausal bleeding or bleeding related to hormone replacement therapy. InterventionAll women had an endometrial biopsy after diagnostic hysteroscopy to exclude endometrial carcinoma or atypical hyperplasia. Then they underwent hysteroscopic surgical resection (203, 62.5%) or endometrial ablation (122, 37.5%). Measurements and Main ResultsTwo cases each (0.6%) of endometrial carcinoma and endometrial atypical hyperplasia were discovered that were missed by preoperative evaluations. ConclusionOutpatient hysteroscopy and endometrial biopsy do not eliminate the finding of carcinoma or endometrial atypical hyperplasia, as these disorders may be discovered during hysteroscopic surgery.