Role of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and its histopathological correlation

Abstract

Background: The aims of this study are 1) To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding. 2) To correlate hysteroscopic findings with histopathology findings. Methods: This is a prospective interventional study conducted in the dept. of obstetrics & gynecology at K.J. Somaiya hospital in the period between January 2010 to December 2012. Women between 20-60 years of age of any parity who presented with complaints of Abnormal Uterine Bleeding (AUB) and who did not require any emergency management were enrolled in the study after excluding pregnancy, uterine/cervical infection/PID, cervical malignancy, H/o uterine perforation, patients on Oral Contraceptive Pills (OCPs), and presence of medical contraindication to any invasive procedure. A total of 98 women were included in the study. They were counselled and informed consent was taken. Patients were evaluated with detailed history, thorough examination and investigations. Hysteroscopy was done under total intravenous anaesthesia followed by endometrial biopsy. Hysteroscopic findings were then correlated with histopathology reports. Results: The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of diagnostic hysteroscopy in the study was 98.3%, 80.5%, 89.7%, 96.7% and 91.8% respectively. For the diagnosis of endometrial hyperplasia these were 92%, 92%, 89%, 94%, and 92 % respectively. For polyp these figures were 94%, 96%, 87%, 98%, 95% respectively; for endometrial atrophy there were 66%, 95%, 60 %, 98% and 94%; for submucous fibroid 91%, 95%, 78%, 98%, and 94%; for malignancy 75%, 98%, 75%, 98%, 97% respectively. Conclusions: With the above results it can be concluded that hysteroscopy is safe, sensitive and reliable diagnostic procedure. However endometrial biopsy improves the diagnostic accuracy of hysteroscopy. Keywords: AUB, Hysteroscopy, Histopathology, Endometrial biopsy