title: Hysteroscopic chasing for endometrial cancer in a low-risk population: risks of overinvestigation.
abstract: OBJECTIVE
  To evaluate the appropriateness of the indications for hysteroscopy done, in fertile and postmenopausal women, for the detection of endometrial cancer.
  
  
  METHODS
  A retrospective analysis of 2673 consecutive women who underwent office hysteroscopy chasing for endometrial cancer between January 2012 and June 2014. According to their medical history only low-risk women entered the study.
  
  
  RESULTS
  A total of 1070 patients entered the study. The main outcome measure was the appropriateness of the indications for hysteroscopy. Appropriateness was assessed on the basis of guidelines of scientific societies and histologic report. According to the algorithm developed for appropriateness, 44 % of procedures resulted in being inappropriate. In reproductive-aged women 57 % of hysteroscopies were inappropriate. In postmenopausal women inappropriate hysteroscopies were 45 %. In reproductive-aged women, the reasons for inappropriateness were: absence of abnormal uterine bleeding (AUB) or AUB without a trial of progestin therapy. In postmenopausal women, the reasons for inappropriateness were: ultrasound report of endometrial thickening or polyp without bleeding.
  
  
  CONCLUSIONS
  Hysteroscopy is often recommended for inappropriate indications. More evidence is needed to identify the risks of overinvestigation, overdiagnosis, and related overtreatment and to better identify the threshold beyond which benefits are likely to outweigh harms.
authors: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.
authors: Federica
authors: F
authors: Scrimin
authors: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy. uri@libero.it.
authors: Uri
authors: U
authors: Wiesenfeld
authors: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.|University of Trieste, Trieste, Italy.
authors: Emanuele F
authors: EF
authors: Galati
authors: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.
authors: Lorenzo
authors: L
authors: Monasta
authors: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.|University of Trieste, Trieste, Italy.
authors: Giuseppe
authors: G
authors: Ricci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D000069342:Medical Overuse; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D047648:Perimenopause; D011127:Polyps / Q000473:pathology*; D017698:Postmenopause; D012189:Retrospective Studies; D012306:Risk; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology / Q000473:pathology; D014594:Uterine Neoplasms / Q000473:pathology*
keywords: Appropriateness; Endometrial cancer; Hysteroscopy