Diagnostic accuracy of hysteroscopy in endometrial hyperplasia

• Published in: Maturitas Vol. 25; no. 3; pp. 187 - 191
• Main Authors: Loverro, Giuseppe, Bettocchi, Stefano, Cormio, Gennaro, Nicolardi, Vittorio, Porreca, Maria Rosaria, Pansini, Nicola, Selvaggi, Luigi
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.11.1996; Elsevier Science
• Subjects: Abnormal uterine bleeding; Adult; Aged; Biological and medical sciences; Biopsy; Diagnosis, Differential; Endometrial hyperplasia; Endometrial Hyperplasia - diagnosis; Endometrial Hyperplasia - pathology; Endometrium - pathology; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysteroscopy; Medical sciences; Middle Aged; Non tumoral diseases; Sensitivity and Specificity; Uterine Hemorrhage - etiology; Uterine Hemorrhage - pathology; Abnormal uterine bleeding; Hysteroscopy; Endometrial hyperplasia; Human; Hyperplasia; Uterine diseases; Female; Diagnosis; Endometrium; Female genital diseases
• ISSN: 0378-5122; 1873-4111
• DOI: 10.1016/S0378-5122(96)01064-X

Objectives: To determine the diagnostic accuracy of hysteroscopy in the diagnosis of endometrial hyperplasia in women with abnormal uterine bleeding. Methods: From 1993 through 1995, 980 women referred to our institution for abnormal uterine bleeding underwent diagnostic hysteroscopy with eye direct biopsy of the endometrium in case of macroscopic abnormalities. Hysteroscopic features were compared with pathologic findings in order to detect the reliability of the endoscopic procedure. Statistical analysis was performed with the McNemar test. Results: Positive predictive value of hysteroscopy in the diagnosis of endometrial hyperplasia accounted for 63%. In fact hysteroscopic diagnosis of endometrial hyperplasia was confirmed at pathologic examination in 81 out of 128 patients. Sensitivity and specificity of the endoscopic procedure accounted for 98% and 95%, respectively. Negative predictive value accounted for 99%, as only two cases of atypical hyperplasia were missed at hysteroscopy. Positive predictive value was higher in postmenopausal patients compared to women in the fertile age (72 vs. 58%). Conclusions: Overall, results appear encouraging, since no case of endometrial hyperplasia was missed by hysteroscopy. The high diagnostic accuracy, associated with a minimal trauma, renders hysteroscopy the ideal procedure for both diagnosis and follow-up of conservative management of endometrial hyperplasia.