Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction.
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.
Pasqualotto
E B
EB
Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH 44195, USA.
Margossian
H
H
Price
L L
LL
Bradley
L D
LD
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
D012965:Sodium Chloride