Diagnostic Accuracy Of Hysteroscopy Research Articles

Diagnostic accuracy of hysteroscopy vs dilation and curettage (D&C) for atypical endometrial hyperplasia in patients performing hysterectomy or serial follow-up

Background: Endometrial hyperplasia (EH) is considered a heterogeneous pre-neoplastic clinical entity characterized by an abnormal glandular proliferation, with less than half of the tissue area occupied by the stroma. The aim of this retrospective study was to evaluate the correlation between the histological diagnosis of atypical endometrial hyperplasia (AEH) obtained through office hysteroscopy (OH) or uterine dilation and curettage (D&C) and the definitive histological evaluation after hysterectomy. Methods: Among 112 patients with atypical EH, 45 (40%) underwent hysteroscopy and 67 (60%) curettage. Results: The diagnostic accuracy of OH was very high: in particular, it showed a diagnostic coincidence in 87% of cases with the definitive histological diagnosis through hysteroscopy. The curettage, instead, had diagnostic coincidence only in 14% of cases. Conclusion: Office hysteroscopy is the ideal procedure for both diagnosis and follow-up of endometrial hyperplasia.

Diagnostic accuracy of hysteroscopy, ultrasound and magnetic resonance imaging in detecting congenital uterine anomalies.

Congenital uterine malformations occur as a result of a defective uterine development. The formation of the uterus is a dynamic process that culminates after completing four phases (differentiation, fusion, migration and canalization). Because is an evolutionary process, the resulting uterine malformation is different depending on the uterine formation phase in which the failure occurs. To establish a correct diagnosis of uterine malformations, it is necessary to evaluate both the shape of the uterine cavity and the external contour of the uterus. In this review we will describe the imaging modalities used in current clinical practice for the evaluation of the patient with suspected congenital uterine anomalies. The current role of each modality is described.

Saline Infusion Sonography Versus Hysteroscopy in Postmenopausal Bleeding

Postmenopausal bleeding (PMB) is bleeding from the vagina that occurs after a woman has stopped having regular menstrual periods due to menopause. Diagnostic tools in postmenopausal women with abnormal uterine bleeding are TVS, SIS, hysteroscopy and biopsy for histopathological examination.To compare diagnostic accuracy of saline infusion sonography with hysteroscopy in detecting intracavitary abnormalities in postmenopausal women with abnormal uterine bleeding. This prospective observational comparative study was conducted at Department of Obstetrics and Gynecology, Benha University Hospitals on 50 female patients complaining of PMB. All patients were subjected to full history taking, examination, transvaginal ultrasonography and routine preoperative investigations. In operation room under general anesthesia, patients were undergoing SIS then hysteroscopy. Biopsy was taken and sent for histopathological examination. Most commonly encountered endometrial lesions were hyperplasia (52%), myoma (16%), polyp (12%) and atrophy (12%). Diagnostic accuracy of hysteroscopy in detection of submucosal myoma was better than SIS and TVS with respect to pathological diagnosis. There was an agreement between SIS and hysteroscopy in the diagnosis of polypoid lesions of uterine cavity with sensitivity and specificity of 100%, being more accurate than TVS. The diagnostic accuracy of SIS in the detection of endometrial hyperplasia was better than hysteroscopy and better than TVS with respect to pathological diagnosis.Hysteroscopy has the highest diagnostic accuracy for diagnosing endometrial pathology. SIS may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.

Diagnostic accuracy of hysteroscopy, ultrasound and magnetic resonance imaging in detecting congenital uterine anomalies

Diagnostic accuracy of hysteroscopy, ultrasound and magnetic resonance imaging in detecting congenital uterine anomalies

Evaluation of Intrauterine Pathology: Efficacy of Diagnostic Hysteroscopy in Comparison to Histopathological Examination

The aim of this work is to evaluate the diagnostic accuracy of hysteroscopy compared to histopathological findings in cases with intrauterine pathology. This prospective clinical trial was carried out over a period of two years. 280 patients were recruited with an average of 45 years (range: 25-65 years). Two hundred and thirty patients (82.14%) with abnormal findings in ultrasound examinations, the remaining 50 (17.85%) had normal scan, referred mainly because of abnormal uterine bleeding (AUB) and infertility. Hysteroscopic findings divided into; uterine cavity lesions: endometrial or cervical polyps, myomas, cysts, placental derbis, adhesions, congenital malformations and IUCD retention, endometrial characterization including: functional, dysfunctional, atrophic endometrium, hyperplasia, polypoid and carcinoma. Biopsies or removal of pathology were performed and sent for histopathology examinations, results were compared with hysteroscopic findings. Sensitivity, Specificity and predictive value (PV) of hysteroscopy were calculated. Results: Uterine cavity abnormalities were detected in (71.4%) patients, significantly more at ages of >30 years (58.3%) compared with ages of <30 years (34.6%) (P<0.05). In benign endometrial lesions, the sensitivity of hysteroscopy was (98.9%), specificity was (97.5%), positive predictive value was (98.8%), negative predictive value was (98.5%) with diagnostic accuracy of 98.3%, same parameters for endometrial characterization: (78.9%), (90.7%), (82.8%), (90.9%) with diagnostic accuracy of 87.8%. Conclusions: Hysteroscopy allows direct visualization of uterine cavity, it is a safe and reliable procedure for evaluating benign endometrial lesion, but in view of poor validity to exclude endometrial hyperplasia and cancer, it is recommended always to perform diagnostic hysteroscopy combined with biopsy procedures, giving it an irreplaceable value in diagnosis and treatment of intrauterine disease.

Diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies and appropriateness of performed hysteroscopies among asymptomatic postmenopausal women

ObjectiveTo measure the diagnostic accuracy of endometrial thickness for the detection of intra-uterine pathologies among asymptomatic postmenopausal women, and to test the diagnostic accuracy and appropriateness of performed hysteroscopies. Study designProspective study of 268 asymptomatic postmenopausal women with endometrial thickness ≥4mm referred to diagnostic hysteroscopy. The diagnostic accuracy of various endometrial thickness cut-off values was tested. Histological and hysteroscopic results were compared to measure the diagnostic accuracy of outpatient hysteroscopies. ResultsNo endometrial thickness cut-off values had optimal diagnostic accuracy [positive likelihood ratio (LR+) >10 and negative likelihood ratio (LR−) <0.1]. The best endometrial thickness cut-off value for the detection of all intra-uterine pathologies was ≥8mm (LR+ 10.05 and LR− 0.22). An endometrial thickness cut-off value ≥10mm did not miss any cases of endometrial cancer. The success rate of diagnostic hysteroscopy was 89%, but 97% of these revealed a benign intra-uterine pathology. The diagnostic accuracy of hysteroscopy was optimal for all intra-uterine pathologies, except endometrial hyperplasia (LR− 0.52). ConclusionUsing an endometrial thickness cut-off value ≥4mm, only 3% of performed hysteroscopies were useful for the detection of pre-malignant or malignant lesions. Despite the finding that endometrial thickness did not show optimal diagnostic accuracy, using the best cut-off value (≥8mm) may be helpful to decrease the number of false-positive results. No cases of endometrial cancer were diagnosed in asymptomatic postmenopausal women with endometrial thickness <10mm.

Comparison of saline infusion sonohysterography and hysteroscopy in diagnosis of premenopausal women with abnormal uterine bleeding

The aim of this study was to compare the diagnostic effectiveness of transvaginal sonography (TVS), saline infusion sonohysterography (SIS), and diagnostic hysteroscopy (HS), with the pathologic specimen as a gold standard diagnostic method, in detecting endometrial pathology in premenopausal women with abnormal uterine bleeding. This prospective cohort study was conducted at Zeynep Kamil Education and Training Hospital, Istanbul, Turkey, and included 89 premenopausal women. All participants were examined first by TVS, further investigated with SIS and HS, and finally dilatation and curettage was performed when needed. The results obtained from these three methods were compared with the pathologic diagnoses. The positive and negative likelihood ratios (LR+ and LR-) of TVS, SIS and HS were calculated by comparison with the final pathological diagnosis. In addition, area under the curve (AUC) values were also calculated. Polypoid lesion was the most common abnormal pathology. LR+ and LR- of TVS, SIS, and HS were 3.13 and 0.15, 9.83 and 0.07, 13.7 and 0.02 respectively in detection of any abnormal pathology, and the AUCs of TVS, SIS, and HS were 0.804, 0.920, and 0.954 respectively. When the three procedures were compared with each other separately, HS had the best diagnostic accuracy, and the diagnostic accuracy of HS and SIS was superior to TVS (p(1)=0.000, p(2)=0.000). For the detection of polypoid lesions, HS was the most accurate diagnostic procedure (AUC=0.947), followed by SIS (AUC=0.894) and TVS (AUC=0.778). HS provides the most accurate diagnosis and allows treatment in the same session in premenopausal women with abnormal uterine bleeding.

Reliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: A comparative study with transvaginal sonography and MRI

Objective This study aimed at comparing the reliability of diagnostic fluid hysteroscopy, transvaginal sonography (TVS), and magnetic resonance imaging (MRI) to assess pre-operatively the presence of cervical involvement by endometrial carcinoma. Methods Cervical involvement was assessed by diagnostic fluid mini-hysteroscopy, TVS and MRI before surgery in 100 patients with histological diagnosis of endometrial carcinoma. Results were compared with pathological examination on surgical specimen. The sensitivity, the specificity, the positive and negative predictive values, the accuracy, the positive and negative likelihood ratios (LR) of the three techniques for recognizing the cervical involvement by the carcinoma were calculated. Results At histology cervical involvement was found in 15 cases. Compared to TVS and MRI, hysteroscopy showed the highest sensitivity (0.53, 0.67 and 0.93, respectively). The specificity of MRI was significantly higher than both hysteroscopy and TVS (0.95, 0.88 and 0.82, respectively). The diagnostic accuracy of hysteroscopy (0.89) and MRI (0.91) was similar and significantly higher than TVS (0.78). The LR for a positive result of MRI was 14.16, that was 2.08 and 4.68 times higher than that of hysteroscopy and TVS, respectively. Conclusions In conclusion, this study demonstrates that in women with endometrial carcinoma the exclusion of cervical canal involvement at hysteroscopy is more reliable than at MRI and TVS while MRI is the most reliable technique for predicting cervical involvement. In the pre-surgical work-up of patients affected by endometrial carcinoma hysteroscopy and MRI are both useful for staging and planning the correct surgical strategy.

62: Usefulness and Safety of Low Pressure Fluid Mini-hysteroscopy (LPFH) in the Pre-operative Assessment of Endometrial Carcinoma: A 5 Year Follow-up Study

To evaluate: a) the diagnostic accuracy of hysteroscopy in assessing the invasion of the uterine cervix; b) the incidence of endometrial cells spreading after LPFH by endometrial cytology and rate of pelvic recurrence at 5-years follow-up.

Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta‐analysis

This study was conducted to assess the accuracy and feasibility of diagnostic hysteroscopy in the evaluation of intrauterine abnormalities in women with abnormal uterine bleeding. Electronic databases were searched from 1 January 1965 to 1 January 2006 without language selection. The medical subject heading (MeSH) and textwords for the following terms were used: hysteroscopy, diagnosis, histology, histopathology, hysterectomy, biopsy, sensitivity and specificity. University Hospital. The inclusion criteria were report on accuracy of diagnostic hysteroscopy in women with abnormal uterine bleeding compared to histology collected with guided biopsy during hysteroscopy, operative hysteroscopy or hysterectomy. Electronic databases were searched for relevant studies and references were cross-checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated and data were pooled. Subgroup analysis was performed according to validity criteria, study quality, menopausal state, time, setting and performance of the procedure. The pooled sensitivity, specificity, likelihood ratios, post-test probabilities and feasibility of diagnostic hysteroscopy on the prediction of uterine cavity abnormalities. Post-test probabilities were derived from the likelihood ratios and prevalence of intrauterine abnormalities among included studies. Feasibility included technical success rate and complication rate. One population of homogeneous data could be identified, consisting of patients with postmenopausal bleeding. In this subgroup the positive and negative likelihood ratios were 7.9 (95% CI 4.79-13.10) and 0.04 (95% CI 0.02-0.09), raising the pre-test probability from 0.61 to a post-test probability of 0.93 (95% CI 0.88-0.95) for positive results and reducing it to 0.06 (95% CI 0.03-0.13) for negative results. The pooled likelihood ratios of all studies included, calculated with the random effects model, were 6.5 (95% CI 4.1-10.4) and 0.08 (95% CI 0.07-0.10), changing the pre-test probability of 0.46 to post-test probabilities of 0.85 (95% CI 0.78-0.90) and 0.07 (0.06-0.08) for positive and negative results respectively. Subgroup analyses gave similar results. The overall success rate of diagnostic hysteroscopy was estimated at 96.9% (SD 5.2%, range 83-100%). This systematic review and meta-analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities.

HISTEROSCOPIA DIAGNÓSTICA: RENDIMIENTO EN EL ESTUDIO DE LA METRORRAGIA E INOCUIDAD ANTE UN EVENTUAL CÁNCER DE ENDOMETRIO, REVISIÓN DE LA LITERATURA

SUMMARY Objective: To asses the accuracy of diagnostic hysteroscopy in the study of endometrium in patients with abnormal bleeding and to determine the risks of this procedure in patients with endometrial cancer. Methods: Non systematic review of MEDLINE based literature and manual search of relevant articles references. Results: Seven meta-analysis were identified. They included 43,757 patients who underwent through different endometrial diagnostic tests. In this data, diagnostic accuracy of hysteroscopy was compared against endometrial sampling, transvaginal ultrasound and hysterosonography. The gold standard was the anatomo pathologic findings. Hysteroscopy and endometrial sampling were found to have the highest specificitiy, which make them useful tests in the management of women with abnormal endometrial thickness in transvaginal ultrasound. Authorized recommendations were reviewed as well as the evidence in favor and against of performing hysteroscopy in endometrial cancer patients. Conclusion: There is neither enough evidence to support the safety of diagnostic hysteroscopy in this group of patients, nor to state that the procedure correlates with worse prognosis. Based on the existing evidence, the authors propose a study

Diagnostic Hysteroscopy in Endometrial Hyperplasia

Objectives: To assess the reproducibility of hysteroscopic diagnosis in the various types of endometrial hyperplasias and to compare different classifications of endometrial hyperplasia from this point of view. Study Design: 109 endometrial hyperplasias, diagnosed in the last 5 years with hysteroscopy, were all biopsied and had a pathological examination. We tried to estimate the accuracy of hysteroscopy comparing the various classifications of endometrial hyperplasia to the final pathologic diagnosis. Results: Using older endometrial hyperplasia classification, the overall diagnostic accuracy of hysteroscopy was 76% as for the correct type of hyperplasia. Classifying them at hysteroscopy into two categories only, i.e. hyperplasias and neoplasias, gave a more accurate result (90.26%). Conclusions: The newer classification is better from the hysteroscopist’s point of view.

Comparison of Hysteroscopic and Hysterectomy Findings to Assess the Diagnostic Accuracy of Office Hysteroscopy in Tamoxifen-Treated Patients with Breast Cancer

Study Objective To assess the diagnostic accuracy of office hysteroscopy by comparing hysteroscopic findings with histologic findings on hysterectomy specimens in postmenopausal women with breast cancer treated with tamoxifen. Design Retrospective clinical study (Canadian Task Force classification II-2) Setting University-affiliated hospital. Patients Thirty-three women. Intervention Record review. Measurements and Main Results Compared with histologic diagnoses of uteri, hysteroscopic findings showed diagnostic sensitivity of 97%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96%. The diagnostic accuracy of hysteroscopy is the same in patients taking tamoxifen as in the general population. Conclusion Hysteroscopy is a powerful method for diagnosing endometrial disease because it provides a direct view of the uterine cavity, reveals focal lesions, and enables targeted biopsies to be performed at the same time.

Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review.

Hysteroscopy (direct endoscopic visualization of the endometrial cavity) is used extensively in the evaluation of common gynecologic problems, such as menorrhagia and postmenopausal bleeding. However, there is a continuing debate about the value of this technology in the diagnosis of serious endometrial disease. To determine the accuracy of hysteroscopy in diagnosing endometrial cancer and hyperplasia in women with abnormal uterine bleeding. Relevant articles were identified through searches of the Cochrane Library, MEDLINE, and EMBASE (1984-2001), manual searches of bibliographies of known primary and review articles, and contact with manufacturers. Studies were selected blindly, independently, and in duplicate if accuracy of hysteroscopy was estimated in women with abnormal uterine bleeding, using histopathologic findings as a reference standard. Our search identified 3486 articles; 208 of these were deemed to be potentially eligible and were retrieved for detailed data extraction. Sixty-five primary studies were analyzed, including 26 346 women. Data were abstracted on characteristics and quality from each study. Results for diagnostic accuracy were extracted to form 2 x 2 contingency tables separately for endometrial cancer and endometrial disease (cancer, hyperplasia, or both). Pooled likelihood ratios (LRs) were used as summary accuracy measures. The pretest probability of endometrial cancer was 3.9% (95% confidence interval [CI], 3.7%-4.2%). A positive hysteroscopy result (pooled LR, 60.9; 95% CI, 51.2-72.5) increased the probability of cancer to 71.8% (95% CI, 67.0%-76.6%), whereas a negative hysteroscopy result (pooled LR, 0.15; 95% CI, 0.13-0.18) reduced the probability of cancer to 0.6% (95% CI, 0.5%-0.8%). There was statistical heterogeneity in pooling of LRs, but an explanation for this could not be found in spectrum composition and study quality. The overall accuracy for the diagnosis of endometrial disease was modest compared with that of cancer, and the results were heterogeneous. The accuracy tended to be higher among postmenopausal women and in the outpatient setting. The diagnostic accuracy of hysteroscopy is high for endometrial cancer, but only moderate for endometrial disease (cancer or hyperplasia).

HYSTEROSCOPY AND ADENOCARCINOMA

Although the diagnostic accuracy of hysteroscopy is high, it should be considered a diagnostic technique and used together with endometrial biopsy. Hysteroscopy is useful for excluding those patients with abnormal uterine bleeding who show no signs of intrauterine pathology. The number of cases in which hysteroscopy is sufficient for reaching a diagnosis without the help of a subsequent biopsy will depend directly on the experience of the endoscopist. After a fair amount of practice, it is possible to use hysteroscopy for the identification of patients with either benign or malignant endometrial lesions with about 20% false positives and no false negatives. The combined use of hysteroscopy and biopsy leads to near 100% accuracy in the diagnosis of endometrial neoplasia and its precursors. The combination of hysteroscopy and endometrial biopsy is ideal for use in symptomatic patients for the early detection of endometrial neoplasia, its precursors, and benign lesions that cause abnormal bleeding. With benign and malignant endometrial lesions, the first symptom is generally bleeding. Zampi and coworkers analyzed the hysteroscopic finding and menometrorrhagia in 1295 women. While cystic hyperplasia and endometrial neoplasia gave rise to bleeding in many patients, many other lesions also caused the same symptom. Hysteroscopy represents the ideal technique for the examination of women over the age of 45 who complain of abnormal uterine bleeding. In association with endometrial biopsy, it can detect endometrial adenocarcinoma in its early stages and select those patients who have precursor lesions.