The efficacy of hysteroscopy in diagnosis and treatment of endometrial pathology

Abstract

Hysteroscopy has become the first choice approach for patients with suspicion for intrauterine lesions. The one-stop approach in which diagnosis and hysteroscopic treatment is performed in one session has been described as being highly appreciated by the patient, has a low risk profile, and is a cost-efficient approach. This study addresses the value of hysteroscopy on diagnostic accuracy and its effectiveness to the one-stop therapeutic approach. This is a prospective study of patients admitted in the ambulatory surgery unit of the Sto. André–Leiria Hospital (Portugal) from February 2005 to February 2008 for a one-stop diagnostic and therapeutic approach. Patient selection was done on transvaginal ultrasound findings or on clinical pathology. Depending on the transvaginal ultrasound report and the clinical data, the instrumentation and analgesia for the one-stop approach was defined. The average age was 54 years (range24–87 years). The majority of patients (96.2%) presented with a transvaginal ultrasonographic lesion. The hysteroscopic evaluation characterized the hysteroscopic findings in two groups: the “uterine cavity lesions” (endometrial and cervical polyps, myomas, malignant smooth muscle tumor, placenta or first trimester debris, bone, adhesions or septum, lost IUD, or no lesion) and “the endometrial characterization” (which include functional atrophic or thin endometrium, dysfunctional, endometritis, cystic atrophy, hyperplasia, polypoid, and carcinoma). We concluded that the ambulatory performance of direct visualization of uterine cavity by hysteroscopy guarantees a high diagnostic accuracy, allowing the simultaneous accomplishment of biopsies and surgical treatment of the visualized lesions.