Can in-office hysteroscopy reliably evaluate uterine pathology?
According to a new retrospective analysis in Menopause, outpatient hysteroscopy may be a reliable tool for evaluating and diagnosing uterine pathology.
Researchers studied data from all women who had been referred to a tertiary center outpatient hysteroscopy clinic between March 2011 and October 2016 for any of the following indications: thick endometrium, postmenopausal bleeding, and suspected polyp. Specimens obtained by hysteroscopy and hysterectomy were compared and evaluated for histological accuracy. Visual accuracy of hysteroscopy was evaluated by comparison with specimens collected through biopsy. Likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were calculated to examine visual accuracy.
The average age of women in the study was 54.14 (interquartile range 43.0-64.0). During the 712 visits recorded in the clinic log, a total of 408 pathological specimens were collected through outpatient hysteroscopies. Histological accuracy was examined in 15 women who eventually had hysterectomies. The total percent of agreement between hysteroscopy biopsies and pathology found by hysterectomy was 73% (kappa = 0.47). Visual accuracy was calculated with a 93.1% sensitivity, 52.1% specificity, 90.4% PPV, and 61.0% NPV.
Visual accuracy with hysteroscopy was generally higher for benign pathology than for pre- and malignant lesions. It was poor for diagnosis of hyperplasia, with sensitivity and specificity of 25.0% and 96.6%, respectively. For diagnosis of endometrial carcinoma, it was satisfactory, with sensitivity and specificity of 71.4% and 98.9%, respectively.
The researchers concluded that outpatient hysteroscopy is an adequate tool for evaluating benign pathology in the uterus. However, visual findings may not be sufficient and directed biopsies may be needed to improve diagnostic accuracy.