The role of outpatient diagnostic hysteroscopy in identifying anatomic pathology and histopathology in the endometrial cavity

Study Objective. To evaluate the role of outpatient diagnostic hysteroscopy. Design. Retrospective review (Canadian Task Force classification IL-2). Setting. University, teaching hospital-based outpatient clinic. Patients. One thousand six hundred women, 67.3% premenopausal and 32.7% postmenopausal. Intervention. Diagnostic hysteroscopy without premedication or anesthesia; endometrial sampling or hysteroscopy-guided biopsy was performed when appropriate. Measurements and Main Results, Outpatient hysteroscopy was successfully performed in 1468 women (91.8%). Eleven women (0.7%) developed vasovagal response during the procedure, 18 required hospital admission because of pain or hemorrhage, and 2 were suspected of having uterine perforation. A II recovered spontaneously without intervention, Intrauterine anatomic pathology was diagnosed in 17.0%; the overall Frequency of myomas and endometrial polyps was 12.3% and 7.1%, respectively. The sensitivity and positive predictive value of hysteroscopy without biopsy in diagnosing endometrial carcinoma were only 58.8% and 20.8%, respectively OF 1112 women with hysteroscopic impression of normal or atrophic endometrium, 10 (0.9%) had endometrial hyperplasia on biopsy Conclusion. Hysteroscopy without biopsy carries low sensitivity and positive predictive value in the diagnosis of endometrial carcinoma and hyperplasia. In our opinion the predictive value of a negative hysteroscopy is inadequate, and endometrial biopsy should be performed during hysteroscopy for accurate diagnosis of endometrial histopathology.