Role of hysteroscopy in evaluating patients with abnormal uterine bleeding and its correlation with histopathology
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261625Keywords:
Abnormal uterine bleesing, Diagnostic accuracy, Histopathology, HysteroscopyAbstract
Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint with diverse aetiologies that often require precise evaluation to guide management. Hysteroscopy, by allowing direct visualization of the uterine cavity, has emerged as a superior diagnostic tool compared to traditional methods such as dilation and curettage. Objectives were to determine the spectrum of intrauterine abnormalities contributing to AUB through hysteroscopic evaluation, assess the diagnostic potential of hysteroscopy, and correlate its findings with histopathology.
Methods: An analytical observational study was conducted in the department of obstetrics and gynecology at Sparsh Hospital, Bangalore, from January 2023 to December 2024, involving 210 women with AUB. All participants underwent detailed clinical evaluation, transvaginal sonography (TVS), hysteroscopy, and endometrial biopsy. Hysteroscopic findings were compared with histopathological results, and diagnostic validity parameters- sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy- were calculated using SPSS v20.
Results: Most patients were aged 41-50 years (35.24%). Heavy menstrual bleeding was the commonest presentation (36.6%). Hysteroscopy revealed endometrial polyps (30.47%) and hyperplasia (21.4%) as predominant findings. Histopathology confirmed polyps in 28.5% and hyperplasia in 18.08%. Hysteroscopy showed sensitivity of 95.18%, specificity of 84.92%, PPV of 82%, NPV of 96.31%, and diagnostic accuracy of 90.05% in comparison to histopathology.
Conclusions: Hysteroscopy is a highly accurate, safe, and minimally invasive diagnostic modality for evaluating AUB. When combined with histopathology, it serves as the gold standard for identifying intrauterine pathology and guiding appropriate management.
References
Karimi M, Alizadeh A, Mahmoodi M. Clinicopathological pattern of endometrial specimens in women with abnormal uterine bleeding and ultrasonography correlation. Arch Iran Med. 2024;27(4):216-22.
Goyal BK, Gaur I, Sharma S. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Med J Armed Forces India. 2015;71(2):120-5.
Akdan E, Yücel N, Adıgüzel FI. The frequency of structural causes (PALM) according to FIGO PALM-COEIN classification in patients undergoing hysterectomy for abnormal uterine bleeding. J Med Palliat Care. 2024;5(3):172-6.
Veena BT, Shivalingaiah N. Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding. Journal of clinical and diagnostic research: J Clin Diagn Res. 2014;8(12):OC06.
Kumar K, Pajai S, Baidya GR, Majhi K. Utility of saline infusion sonohysterography in gynecology: a review article. Cureus. 2023;15(2):e35424.
Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol. 1975;45:537-41.
Rock JA, Jones HW III, eds. Te Linde’s Operative Gynecology. New Delhi: Wolters Kluwer Health/Lippincott Williams and Wilkins; 2009:336-368.
Pasqualotto EB, Margossian H, Price LL. Accuracy of preoperative diagnostic tools and outcomes of hysteroscopic management of menstrual dysfunction. J Am Assoc Gynecol Laparosc. 2000;7:201-9.
Van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114:664-75.
Valle RF. Hysteroscopic evaluation of patients with abnormal uterine bleeding. Surg Gynecol Obstet. 1981;153:521-3.
Patil SG, Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation. J Gynecol Endosc Surg. 2009;1:98-104.
Sharma P, Jaggi R, Thakyal A. Role of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and its histopathological correlation. Int J Clin Obstet Gynecol. 2022;6(1A):1-5.
Pradhan B, Pun I, Lama S. Hysteroscopy in abnormal uterine bleeding. Nepal J Obstet Gynecol. 2020;15(2):59-63.
Mohite AM, Kapote D, Fonseca M. Role of diagnostic hysteroscopy in evaluating patients with abnormal uterine bleeding in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2021;10(11):4147-52.
Shivanagappa M, Veerabhadrappa VK, Mahesh M. Diagnostic role of hysteroscopy in abnormal uterine bleeding: a comparative study of hysteroscopy findings with histopathology from Mysore, South India. Int J Reprod Contracept Obstet Gynecol. 2019;8(1):133-8.
Desai S, Srivalli V, Desai N. Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding at a tertiary care centre, Secunderabad, India. Int J Reprod Contracept Obstet Gynecol. 2021;10(4):1520-5.
Raut SS, Babbar K. Diagnostic comparison of ultrasonography, hysteroscopy and histopathology in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2024;13(1):45-50.
Nandan N, Manjeera L, Rai S, Gowri M. Diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation: our experience. J Clin Diagn Res. 2013;7(3):613-7.
Revel A, Shushan A. Investigation of the infertile couple: hysteroscopy with endometrial biopsy is the gold standard investigation for abnormal uterine bleeding. Hum Reprod. 2002;17(8):1947-9.
Biswas D, Kanniga R, Ratnani R, Ray R. Diagnostic hysteroscopy is a better method for diagnosis and management of abnormal uteri ne bleeding than traditional methods- an Indian perspective. J Med Sci Res. 2022;10(2):65-70.
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