Use of Hysteroscopy in Abnormal Uterine Bleeding: An Edge Over Histopathological Examination.

Abstract

To assess the efficacy of hysteroscopy in diagnosis of AUB. A total of 56 women in reproductive and peri-menopausal age group (20-50years) with complaints of abnormal uterine bleeding were enrolled in the study. All the patients underwent hysteroscopic examination followed by biopsy/histopathological evaluation. Hysteroscopic findings were compared against histopathological findings. Sensitivity, specificity, PPV, NPV and accuracy of hysteroscopy were calculated. Mean age of patients was 36.4±7.6. Majority (60.7%) presented within 6months of complaints. Clinically, 66.1% were diagnosed as menorrhagia, 30.4% polymenorrhoea and 3.6% intermenstrual bleeding. Hysteroscopically 53.6% presented with abnormal pathology, it diagnosed polyps in 16.1%, calcification in 12.5%, submucous fibroma in 10.7%, necrotic mass in 7.1%, adhesion and forgotten IUCD in 5.4% cases each. However, on histopathology, 33 (58.9%) cases had normal/proliferative/atrophic endometrium, 12 (21.4%) had hyperplasia, 7 (12.5%) had calcified endometrium, and 12 (21.4%) had polyp. No significant difference between two modalities was observed with respect to number of normal/proliferative/atrophic endometrium (p=0.185). Histopathology diagnosed hyperplasia in significantly higher proportion of patients as compared to hysteroscopy (p=0.042). Hysteroscopy diagnosed significantly higher proportion of patients with submucous myoma (p=0.012) and necrotic mass (p=0.042). Statistically, no significant difference between two modalities was observed with respect to other pathologies (p>0.05). Overall agreement between two modalities was 62.5%. For pathological abnormalities in general, hysteroscopy had sensitivity, specificity, PPV, NPV and accuracy values of 78.3, 63.6, 60, 80.8 and 69.6%, respectively. Hysteroscopy provided additional information for some of the pathologies, otherwise remaining undiagnosed by HPE.