title: Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction.
abstract: OBJECTIVE
  To review diagnoses, complications, and surgical findings in women treated for abnormal uterine bleeding by operative hysteroscopy, and to assess the accuracy of preoperative transvaginal ultrasound (TVS), saline-infusion sonography (SIS), diagnostic hysteroscopy, and endometrial biopsy.
  
  
  METHODS
  Retrospective study (Canadian task force classification II-2).
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Three hundred seventy-five women. Intervention. Operative hysteroscopy for abnormal uterine bleeding.
  
  
  RESULTS
  Main indications for hysteroscopy were postmenopausal bleeding (164 patients, 43.7%) and abnormal premenopausal uterine bleeding (211, 56.3%). Main pathology findings were endometrial polyps (172, 45.9%) and submucous myomas (105, 28%). Polyps had histologic abnormalities in 18 patients. Sensitivity of preoperative diagnostic tools for all intrauterine abnormalities and specifically for myomas and polyps was TVS 74% and 39%, SIS 96% and 96%, hysteroscopy 100% and 99%, and Pipelle biopsy 24% and 10%. The complication rate was 1.3%. Postmenopausal women felt significantly more improvement in symptoms (p = 0.02), and were more satisfied (p </=0.001) than premenopausal women. Only 10 women had repeat surgery for the problem.
  
  
  CONCLUSIONS
  Operative hysteroscopy is a safe outpatient procedure and is associated with high satisfaction in carefully selected patients. Hysteroscopy and SIS are better diagnostic tests for intracavitary abnormalities than TVS and endometrial biopsy.
authors.affiliation: Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH 44195, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Pasqualotto
authors.forename: H
authors.initials: H
authors.lastname: Margossian
authors.forename: L L
authors.initials: LL
authors.lastname: Price
authors.forename: L D
authors.initials: LD
authors.lastname: Bradley
mesh_terms: D001706:Biopsy; D016889:Endometrial Neoplasms / Q000473:pathology; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D015907:Hysteroscopy; D007890:Leiomyosarcoma / Q000473:pathology; D008599:Menstruation Disturbances / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008875:Middle Aged; D011127:Polyps / Q000473:pathology; D017698:Postmenopause; D012189:Retrospective Studies; D012965:Sodium Chloride; D014463:Ultrasonography
chemical_list: D012965:Sodium Chloride