E Valli

Outpatient diagnostic hysteroscopy.

STUDY OBJECTIVE To evaluate the feasibility, validity, indications, and results of a large series of diagnostic hysteroscopies performed without anesthesia. DESIGN Retrospective analysis of hysteroscopy charts performed between 1989 and 1996 (Canadian Task Force classification II-2). SETTING University-affiliated endoscopy unit. PATIENTS Four thousand consecutive women referred for different indications. INTERVENTIONS Diagnostic hysteroscopy was performed in 91% of patients without premedication or anesthetics. In some women premedication or general or local anesthesia was required to access the uterine cavity. MEASUREMENTS AND MAIN RESULTS The success rate, validity indication, complication rate, and number of biopsies were critically evaluated and assessed in relation to increased experience of operators. In 91% of women we accessed the uterine cavity at the first attempt without premedication, whereas 207 (5. 1%) patients required local anesthesia and 99 (2.4%) premedication. Only 1.6% required general anesthesia. In 52% intrauterine pathology was diagnosed and in 21% further surgical treatment was suggested. CONCLUSION Hysteroscopy was feasible when performed in an outpatient setting without general or local anesthesia in more than 90% of women. The operators experience seems a key factor both for accurate endometrial evaluation and to reduce failure and endometrial biopsy rates. The low frequency of further surgical treatment justifies performing the procedure in the office.

A New Hysteroscopic Classification of and Nomenclature for Endometrial Lesions

STUDY OBJECTIVE To establish a hysteroscopic classification of endometrial lesions based on a combined score: DESIGN A prospective study to grade four features of endometrial lesions (thickness, surface, color, vascularization) and subdivide them as mild (low risk) and severe (high risk). SETTING Gynecologic endoscopy unit of an obstetric and gynecology clinic. PATIENTS Two hundred twenty-nine women with hysteroscopically diagnosed endometrial lesions. INTERVENTIONS Hysteroscopic inspection of endometriotic lesions, with grading performed on the four features. MEASUREMENTS AND MAIN RESULTS The sensitivity and specificity of our system were 86.9% and 87.4% for mild pathology, and 96% and 92.9% for severe pathology. CONCLUSIONS This hysteroscopic classification of endometrial pathology can be useful for a better definition of endometrial lesions. The method has good sensitivity and specificity.

Costs and benefits of office diagnostic hysteroscopy

In Italy, the main location for performing diagnostic hysteroscopy is the office. The success of office hysteroscopy is related to savings of time and money and the convenience for the physician and patient. We evaluated 4000 diagnostic hysteroscopies performed between January 2, 1989, and March 1, 1996. In 17.8% of these patients we subsequently performed operative hysteroscopies (metroplasty, synechiolysis, myomectomy, polypectomy for polyps >2 cm), and in 5.2% a total abdominal hysterectomy for abnormal uterine bleeding or endometrial cancer. The low percentage of operations underlines the efficacy of office diagnostic hysteroscopy, especially if we evaluate costs and accuracy of this procedure in detecting uterine pathologies.

Vaginal Ultrasonography and Diagnostic Hysteroscopy for Women with Abnormal Uterine Bleeding after Menopause

Three hundred twenty-five postmenopausal women with abnormal uterine bleeding had transvaginal ultrasound examinations. In 158 the endometrial thickness was greater than 5 mm, in 20 less than 5 mm but irregular, and in 147 less than 5 mm and regular. Diagnostic hysteroscopy was performed in the first two groups and showed mild endometrial abnormalities in 23 women, severe in 23, endometrial polyps in 55, myoma in 10, and normal endometrium (atrophic or proliferative) in 22, with synechiae in 5. Forty-six (32%) endometrial biopsies were performed and showed 20 adenocarcinomas, 3 atypical hyperplasias, 10 simple hyperplasias, 5 atrophies, and 8 proliferative. In 18 patients the examination was not possible because of cervical stenosis and was performed under general anesthesia; polyps were removed by operative hysteroscopy. In patients with endometrial thickness greater than 5 mm, hysteroscopy revealed only two cases of mild endometrial abnormalities (cystic atrophy), two polyps, and two myomas. The frequency of endometrial cancer was 7%, similar to that reported by others. Ultrasonography is sensitive in evaluating abnormal uterine bleeding with or without endometrial pathology. Hysteroscopy must be the second procedure because it can exclude pathology and allow a targeted biopsy to confirm the diagnosis.

Hysteroscopic evaluation in patients with thick enedendometrium at vaginal ultrasound examination

The purpose of this study was to evaluate the hysteroscopic appearance of the endometrium in cases with abnormal thickening (>8mm) evaluated by vaginal ultrasound. We considered postmenopausal patients who were asymptomatic and those with abnormal uterine bleeding (AUB). Hysteroscopy with endometrial biopsy revealed cancer, hyperplasia, polyps, and myoma in patients with AUB. In the asymptomatic group with increased endometrial thickening, hysteroscopy revealed hyperplasia, polyps and myoma. Our results show that vaginal ultrasound is a reliable method for evaluation of the endometrium in postmenopausal women. Hysteroscopic examination is required to assess the endometrial pathology, and to determine which patients will require biopsy or surgical intervention.