Correlación de la histeroscopia y biopsia dirigida en el estudio del engrosamiento endometrial patológico por ultrasonido

Abstract

Objective: Comparison of hysteroscopy with biopsy in pre- and post -menopausic patients with endometrial thickening on ultrasound. Methods: Retrospective study of 265 patients with pathologic endometrial thickening on transvaginal ultrasound and evaluated with hysteroscopy and biopsy. Results: 68.7% of the patients had benign hysteroscopy results, 15.1% were normal, 10.6% were potentially malignant, and 5.6% were malignant. The most frequent biopsy results were: endometrial polyp (n= 92, 34.7%), proliferate / secretor endometrium (n= 84, 31.7%), and submucosal myoma (n=38, 14.3%). All of the endometrial cancers (n= 9) were in post- menopausic women, with no history of hormone replacement therapy and with endometrial thickening ≥ 11mm. Sensitivity and specificity for hysteroscopy in comparison to biopsy for diagnosing benign pathology were 90.7% (95% CI 85.2 - 94.3) and 65.4% (95% CI 55.8 - 73.8), and the positive and negative predictive values were 80.2% (95% CI 73.8 - 85.4) and 81.9% (95% CI 72.3 - 88.7). Sensitivity and specificity for hysteroscopy in comparison to biopsy for diagnosing endometrial hyperplasia were 60% (95% CI 31.3 - 83.2) and 91.4% (95% CI 87.3 - 94.2), the positive and negative predictive values were 21.4% (95% CI 10.7 - 39.5) and 98.3% (95% CI 95.7 - 99.3). Sensitivity and specificity for hysteroscopy in comparison to biopsy for diagnosing endometrial cancer were 95% (95% CI 65.5 - 99.5) and 97.9% (95% CI 95.2 - 99), positive and negative predictive values were 63.3% (95% CI 38.7 - 82.5) and 99.7% (95% CI 98.1 - 99.8). Conclusion: 85% of the patients with endometrial thickening had an abnormal hysteroscopy result, which latter were confirmed in 80% of the cases with biopsy. In a center with experience, a normal hysteroscopy result can make biopsy unnecessary. Potentially malignant hysteroscopys tend to be over diagnosed, making biopsy fundamental. All endometrial cancers were detected by hysteroscopy in our study.