[Reliability of the diagnostic fluid mini-hysteroscopy in the diagnosis of intrauterine pathologies].
OBJECTIVE
The aim of this study was to determine the diagnostic accuracy of minihysteroscopy with fluid distention and vaginoscopic approach for the diagnosis of endometrial pathologies.


METHODS
This controlled clinical study was conducted on 930 women with endometrial abnormalities who referred to our Department of Obstetrics and Gynecology, University Medical School of Bari, to perform hysterectomy. One week before hysterectomy all the patients underwent minihysteroscopy with fluid distention. Histological diagnoses were compared with the hysteroscopic findings, and the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were determined.


RESULTS
Hysteroscopy was technically successful in all women and revealed sensitivity of 98%, specificity of 99%, a positive predictive value of 92%, a negative predictive value of 99%, and diagnostic accuracy of 99% for the diagnosis of endometrial carcinoma.


CONCLUSIONS
Size reduction of the hysteroscope is of greatest importance for reducing pain and risk of vasovagal reaction. In conclusion, the best approach in terms of ease, reliability, acceptability, and safety to patients in whom intrauterine exploration is indicated should be simple diagnostic mini-hysteroscopy using a small-diameter, rod lens hysteroscope with a single-flow diagnostic sheath, vaginoscopic approach, and fluid distention. In this way in about 90% of patients, a correct diagnosis and proper choice for eventual subsequent operative strategy can be obtained, without discomfort and risk.
Cicinelli
E
E
Dipartimento di Ostetricia e Ginecologia, Università di Bari, Policlinico, Bari, Italia. cicinelli@gynecology1.uniba.it
Tinelli
R
R
Colafiglio
G
G
Mastrolia
S A
SA
Lepera
A
A
Pinto
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007044:Hysterectomy; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014591:Uterine Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery