Predictive value of hysteroscopic examination in intrauterine abnormalities (original) (raw)
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Gynecological Surgery, 2004
Hysteroscopy procedures were retrospectively reviewed in order to reveal the diagnostic accuracy and the efficiency of the diagnostic procedures (transvaginal ultrasonography/TvUsg, saline infusion sonography/SIS, hysteroscopy) for an educational institution in the management of abnormal uterine bleeding. The study was completed in the Department of Gynecology and Obstetrics of the Istanbul University Cerrahpaşa School of Medicine by reviewing the hospital records of the patients on whom hysteroscopy had been performed between 1 January 1997 and 31 December 2002. The records of 385 patients were eligible. The sensitivity, specificity and positive and negative predictive values for saline infusion sonography and hysteroscopy were calculated for specific histopathological diagnoses. The sensitivity and specificity of hysteroscopy for the detection of endometrial polyps were calculated as 83.9 and 63.0%, respectively. The positive predictive value (PPV) was 74.6% and negative predictive value (NPV) 75.2%. The sensitivity and specificity of saline infusion sonography for the detection of endometrial polyps were found to be 87.2 and 33.3%, respectively. PPV was 71.4% and NPV was 57.6% for SIS. The sensitivity and specificity of hysteroscopy for the detection of submucosal leiomyoma were determined to be 80.0 and 92.4%, respectively. PPV was 43.2% and NPV was 98.0%. The sensitivity and specificity of SIS for the detection of submucosal leiomyoma were 71.4 and 92.3%, respectively. PPV was calculated as 52.6% and NPV as 75.2% for SIS. Due to its high diagnostic accu-racy and lower complication rate even in the educational setting, we believe that hysteroscopy will retain its place as the "gold standard" procedure for the investigation of endometrial pathology. School of Medicine, were reviewed. There were 452 hysteroscopy procedures, of which 385 were eligible for analysis during the study period. In 239 cases, TvUsg records and in 144 cases SIS records were available.
Journal of Obstetrics and Gynaecology Research, 2003
Aim: To investigate the accuracy of hysterosalpingography (HSG) in comparison to hysteroscopy in the detection of intrauterine pathology in patients with infertility, where hysteroscopy is the gold standard. Methods: A prospective, comparative study included 336 patients undergoing both HSG and diagnostic hysteroscopy. Main outcome measures were sensitivity, specificity, positive and negative predictive value, and accuracy rate of HSG. Results: Intrauterine abnormalities were shown on HSG in 286 patients and confirmed in 200 at hysteroscopy. Contrarily intrauterine lesions were detected by hysteroscopy in 4 out of 50 patients in whom HSG were normal. The most common intrauterine finding of 336 patients on hysteroscopy were intrauterine adhesions (IUA) (74), followed by endometrial polyps (56), and submucous myoma, 26 patients. Statistical analysis revealed that HSG in the detection of intrauterine pathology had a sensitivity of 98.0%, specificity of 34.9%, positive predictive value of 69.9%, negative predictive value of 92.0%, and accuracy rate of 73.2% with falsepositive and false-negative rates of 30.1% and 8.0%, respectively. The common incorrect diagnoses of HSG were misdiagnosing a condition of cervical stenosis as severe IUA in 24 patients, endometrial polyps as submucous myoma in 22 out of 50 patients, and submucous myoma as endometrial polyps in 12 out of 72 patients. Conclusions: Hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. If a hysterogram demonstrates intrauterine abnormalities, hysteroscopy should be considered to make a definite diagnosis and treatment. Both procedures should be complementary to each other.
Abnormal uterine bleeding is a frequent condition that can negatively affect the physical, emotional, sexual and professional aspects of women, reducing their quality of life and can lead to anemia. It is necessary to be aware of when patients have severe and acute bleeding, they need urgent treatment, with volumetric replacement and hemostatic substances. Often, situations arise that require prolonged treatment and others in which surgical treatment is necessary. Called endometrial ablation whose surgical technique is capable of destroying or resecting the endometrium, indicated in cases of abnormal uterine bleeding without improving with clinical treatment or with contraindication to it. It is an alternative to hysterectomy in the treatment of benign pathologies, being less invasive and less aggressive, with less morbidity and mortality and with considerable cost reduction. Objective: This study aims to analyze the main indications and procedures used for the study of varieties of pathologies diagnosed by hysteroscopy performed in service between the years 2019 and 2020. Methodology : This is a bibliographic, qualitative and descriptive review that will be carried out through books, reading and analysis of national and international scientific articles, course completion works through consultations in the electronic databases, Pubmed, Virtual Health Library, including electronic journals specialized in the area. For this, this research was divided into two moments that refer: the bibliographic research and case study, using the data collection technique through the results obtained from the patients' exams. Results: The results attested that the presence of endometrial polyps, followed by the atrophic endometrium, integrated the most frequent histological and hysteroscopic diagnoses. Polyps and functional endometrium prevailed in younger patients, while in older women, polyps and endometrial atrophy predominated, both through hysteroscopy and endometrial histology.
The efficacy of hysteroscopy in diagnosis and treatment of endometrial pathology
Gynecological Surgery, 2011
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 costefficient approach. This study addresses the value of hysteroscopy on diagnostic accuracy and its effectiveness to the onestop 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.
Accuracy of Hysteroscopy in Predicting Histopathology of Endometrium in 1500 Women
The Journal of the American Association of Gynecologic Laparoscopists, 2001
Endouterine view by hysteroscopy with or without endometrial sampling, can be considered the diagnostic gold standard to exclude endometrial pathology. Hysteroscopy is more effective in assessing endometrial status than blind techniques such as dilatation and curettage. 2,3 Nevertheless, the literature has scant information about the relationship between detailed features of hysteroscopic views and underlying histology. In general practice it is widely accepted that a hysteroscopy report should mainly distinguish 207 Abstract Study Objective. To estimate the accuracy of hysteroscopy in predicting endometrial histopathology.
Indications of diagnostic hysteroscopy, a brief review of the literature
Gynecological Surgery, 2012
Plenty of authors propose outpatient hysteroscopy as the gold standard diagnostic method for the evaluation of endometrial pathology. This statement has been strengthened in the recent years due to the wide use of smaller diameter hysteroscopic devices, which have made the dilation of the cervix and the use of anesthesia unnecessary. The main purpose of this paper is to summarize the indications of diagnostic hysteroscopy. In this review, we used the most recent publications in MEDLINE and Cochrane Library in order to specify the indications of diagnostic hysteroscopy and the experience that have been obtained till today in the management of certain pathological uterine conditions. The key words we used were diagnostic hysteroscopy, abnormal uterine bleeding, infertility, endometrial cancer. Hysteroscopy provides an accurate method of evaluation and direct visualization of the endometrial cavity and moreover directed biopsy and sampling of suspected lesions. Last years with the continuous development in the hysteroscopy devices, plenty of women benefit surgical hysteroscopy techniques for uterine abnormalities. Hysteroscopy is useful for the diagnosis in patients with abnormal uterine bleeding, with endometrial cancer and in infertile women. Hysteroscopy has the unique advantage of combining a thorough procedure with great diagnostic accuracy. The only disadvantage is that hysteroscopy requires specific teaching and training and has a long learning curve.
Hysterosalpingography Vs Hysteroscopy in the Detection of Intrauterine Pathology in Infertility
Journal of Nepal Health Research Council, 2009
Background: This study was to compare the accuracy of hysterosalpingography (HSG) with hysteroscopy (HSC) in detection of uterine pathology in patients with infertility. Methods: This is a prospective comparative study done among 50 new cases of primary and secondary infertility presenting to infertility clinic of Tribhuvan University Teaching Hospital from March 2006 - 2007. HSG was performed in the proliferative phase of menstrual cycle followed by HSC in the proliferative phase of the same or the following cycle. Intra uterine findings on HSG were evaluated and compared with hysteroscopic findings. Results: Out of 50 cases, HSG revealed normal findings in 49 cases (98%) and HSC demonstrated normal uterine cavity in 44 of the cases (88%). There was one abnormality (2%) shown on HSG (subseptate uterus) which was confirmed at HSC. HSC demonstrated six cases (12%) of intrauterine pathologies and these were endometrial polyps, subseptate uterus and submucous myoma. HSG in the detectio...
Archives of Gynecology and Obstetrics, 2015
The aim of this retrospective observational study was to evaluate the reliability of diagnostic hysteroscopy, routinely performed along with endometrial biopsy, by analyzing and comparing both hysteroscopic and histopathological outcomes in asymptomatic infertile patients, previously to their IVF cycle. Methods The study included 84 consecutive infertile patients who underwent diagnostic hysteroscopy followed by endometrial biopsy. Four-micrometer sections were stained with hematoxylin and eosin and examined microscopically. The data evaluated the frequency and characteristics of endometrial abnormalities found in the biopsies of patients with normal hysteroscopy outcome. Descriptive data are presented as percentages, and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy for diagnosis of endometrial alterations were calculated on the basis of pathologic reports. Results The hysteroscopy evaluation showed 50.0 % of patients with a normal uterine cavity, 40.5 % with endometrial polyps, 6.0 % with endometrial hyperemia, and 3.5 % with other endometrial abnormalities. Among the 42 patients with a normal uterine cavity at hysteroscopic examination, 60.0 % also had a normal biopsy outcome, but in other 40.0 % of patients at least one histopathological abnormal aspect was diagnosed at biopsy. The sensitivity (67.3 %), specificity (80.6 %), PPV (85.4 %) and NPV (59.5 %) of diagnostic hysteroscopy were calculated on the basis of histopathological findings. Conclusions Our results show that diagnostic hysteroscopy demonstrated intrauterine alterations in half of infertile patients; histopathological endometrial alterations suggest high rate of false-negative outcomes. Therefore, diagnostic hysteroscopy and concurrent endometrial biopsy should be used as complementary diagnostic and therapeutic approach, especially for patients with previous IVF failures.
Diagnostic hysteroscopy - a retrospective study of 1545 cases
Mædica, 2012
The development of hysteroscopy has provided a minimally invasive approach to common gynecologic problems, such as abnormal uterine bleeding. Diagnostic hysteroscopy is considered now "the gold standard" by the Association of Professors of Gynecology and Obstetrics (2002) in investigation of abnormal uterine bleeding (AUB) in order to rule out organic endouterine causes of AUB. Although the World Health Organization (WHO) recommends hysterosapingography (HSG) alone for management of infertile women many specialists use hysteroscopy as a first-line routine exam for infertility patients regardless of guidelines. This paper is a retrospective study of 1545 diagnostic hysteroscopies performed in the "Prof. Dr. Panait Sirbu" Obstetrics and Gynecology Hospital between January 1, 2008 and June 30, 2011. The following parameters were studied: diagnostic hysteroscopy indications, type of anesthesia used, correlation between pre-and postoperative diagnoses. Of 1545 diagnos...
Pakistan Journal of Medical and Health Sciences, 2021
Background and Aim: Evaluation of uterine abnormalities is infertility core partto be assessed in impaired reproduction cases. Uterine abnormalities can be assessed by various radiological imaging modalities such as transvaginal sonography, hysterosalpingography and hysterosonography. The current study aims to evaluate the diagnostic accuracy of hysterosonography in diagnosis of uterine lesions by taking hysteroscopy as gold standard. Materials and Methods: This observation-based cross-sectional study was carried out on 108 reproductive-age women at the Department of Obstetrics and Gynecology of Liaquat University of Medical and Health Sciences, Jamshoro during the period from January 2020 to June 2020.These women had uterine abnormalities such as recurrent pregnancy loss, abnormal uterine bleeding, infertility, and clinically diagnosed lesions of intrauterine. All individuals underwent hysteroscopy evaluation.Global sensitivity analysis technique was used to calculate the bias-adju...