Role of Chromohysteroscopy in Patients of Abnormal Uterine Bleeding

Abstract

Abnormal uterine bleeding (AUB) is the most common clinical problem in gynecology with hysteroscopy permitting the direct visualization of uterine cavity to diagnose various intra-uterine lesions. Scientists have incorporated the usage of dyes to stain specific lesions in endometrium which is called as chromohysteroscopy. The present study was conducted on 100 women of perimenopausal age group (40–55 years) with the aim to strengthen the importance of chromohysteroscopy in patients of AUB and to widen its applicability in detecting subtle endometrial changes which can be missed on routine hysteroscopy. On hysteroscopy, endometrium in 88 patients appeared to be normal, and 12 patients had abnormal endometrium (eight hyperplasic, three atrophic, one diffuse polypoidal). Out of these 12, only four patients had confirmed pathology on histopathological examinations (HPE) (two simple hyperplasia, one atrophic endometrium, one carcinoma endometrium). Thus, hysteroscopy had sensitivity of only 26.67% and specificity of 90.59% with PPV of 33.32 and PPV of 87.50 in predicting diffuse endometrial changes. Out of eight HE on hysteroscopy, only two (25%) were confirmed on histopathological examination. On chromohysteroscopy, out of 100 patients, 15 patients had dark stained endometrium, and among these, 12 patients had confirmed endometrial abnormalities on HPE (seven simple hyperplasia, four inflammatory endometrium, one carcinoma endometrium). Thus, chromohysteroscopy has sensitivity of 80.00% in detecting endometrial pathologies. Methylene blue is relatively very safe dye with fewer complications and has more predilections for hyperplastic and inflammatory endometrium. It does not require any sophisticated instrumentation or clinical skills during its usage and can be successfully employed along with hysteroscopy to predict hidden pathological areas during hysteroscopy without any harm.