The role of outpatient diagnostic hysteroscopy in identifying anatomic pathology and histopathology in the endometrial cavity.
OBJECTIVE
To evaluate the role of outpatient diagnostic hysteroscopy.


METHODS
Retrospective review (Canadian Task Force classification II-2).


METHODS
University teaching hospital-based outpatient clinic.


METHODS
One thousand six hundred women, 67.3% premenopausal and 32.7% postmenopausal.


METHODS
Diagnostic hysteroscopy without premedication or anesthesia; endometrial sampling or hysteroscopy-guided biopsy was performed when appropriate.


RESULTS
Outpatient hysteroscopy was successfully performed in 1468 women (91.8%). Eleven women (0. 7%) developed vasovagal response during the procedure, 18 required hospital admission because of pain or hemorrhage, and 2 were suspected of having uterine perforation. All recovered spontaneously without intervention. Intrauterine anatomic pathology was diagnosed in 17.0%; the overall frequency of myomas and endometrial polyps was 12.3% and 7.1%, respectively. The sensitivity and positive predictive value of hysteroscopy without biopsy in diagnosing endometrial carcinoma were only 58.8% and 20.8%, respectively. Of 1112 women with hysteroscopic impression of normal or atrophic endometrium, 10 (0.9%) had endometrial hyperplasia on biopsy.


CONCLUSIONS
Hysteroscopy without biopsy carries low sensitivity and positive predictive value in the diagnosis of endometrial carcinoma and hyperplasia. In our opinion the predictive value of a negative hysteroscopy is inadequate, and endometrial biopsy should be performed during hysteroscopy for accurate diagnosis of endometrial histopathology.
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D004714:Endometrial Hyperplasia / Q000175:diagnosis; D016889:Endometrial Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000175:diagnosis*; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis; D017698:Postmenopause; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014591:Uterine Diseases / Q000175:diagnosis; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery; D014594:Uterine Neoplasms / Q000175:diagnosis*