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Evaluation of Intrauterine Pathology: Efficacy of Diagnostic Hysteroscopy in Comparison to Histopathological Examination

Aisha M Elbareg, Mohamed O Elmahashi and Fathi M Essadi

The aim of this work is to evaluate the diagnostic accuracy of hysteroscopy compared to histopathological findings in cases with intrauterine pathology. This prospective clinical trial was carried out over a period of two years. 280 patients were recruited with an average of 45 years (range: 25-65 years). Two hundred and thirty patients (82.14%) with abnormal findings in ultrasound examinations, the remaining 50 (17.85%) had normal scan, referred mainly because of abnormal uterine bleeding (AUB) and infertility. Hysteroscopic findings divided into; uterine cavity lesions: endometrial or cervical polyps, myomas, cysts, placental derbis, adhesions, congenital malformations and IUCD retention, endometrial characterization including: functional, dysfunctional, atrophic endometrium, hyperplasia, polypoid and carcinoma. Biopsies or removal of pathology were performed and sent for histopathology examinations, results were compared with hysteroscopic findings. Sensitivity, Specificity and predictive value (PV) of hysteroscopy were calculated.
Results: Uterine cavity abnormalities were detected in (71.4%) patients, significantly more at ages of >30 years (58.3%) compared with ages of <30 years (34.6%) (P<0.05). In benign endometrial lesions, the sensitivity of hysteroscopy was (98.9%), specificity was (97.5%), positive predictive value was (98.8%), negative predictive value was (98.5%) with diagnostic accuracy of 98.3%, same parameters for endometrial characterization: (78.9%), (90.7%), (82.8%), (90.9%) with diagnostic accuracy of 87.8%.
Conclusions: Hysteroscopy allows direct visualization of uterine cavity, it is a safe and reliable procedure for evaluating benign endometrial lesion, but in view of poor validity to exclude endometrial hyperplasia and cancer, it is recommended always to perform diagnostic hysteroscopy combined with biopsy procedures, giving it an irreplaceable value in diagnosis and treatment of intrauterine disease.