title: Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women.
abstract: OBJECTIVE
  Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity.
  
  
  METHODS
  Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo.
  
  
  METHODS
  Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy.
  
  
  RESULTS
  There were 510 patients, with a mean age of 61.1+/-2.0 years and mean time elapsed since the menopause of 12.7+/-2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively.
  
  
  CONCLUSIONS
  Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.
authors.affiliation: Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Camila Toffoli
authors.initials: CT
authors.lastname: Ribeiro
authors.forename: Júlio César
authors.initials: JC
authors.lastname: Rosa-E-Silva
authors.forename: Marcos Felipe
authors.initials: MF
authors.lastname: Silva-de-Sá
authors.forename: Ana Carolina Japur de Sá
authors.initials: AC
authors.lastname: Rosa-E-Silva
authors.forename: Omero Benedicto
authors.initials: OB
authors.lastname: Poli Neto
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Candido Dos Reis
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Nogueira
mesh_terms: D001706:Biopsy; D004714:Endometrial Hyperplasia / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods* / Q000592:standards; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D017698:Postmenopause; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014463:Ultrasonography