Role of chromohysteroscopy in detection of endometrial pathology in abnormal uterine bleeding
Keywords:Abnormal uterine bleeding (AUB), Chromohysteroscopy, Endometrial aspiration biopsy, Hysteroscopy
Background: Abnormal uterine bleeding is one of the most common clinical problems encountered in gynaecological practice. Chromohysteroscopy is thought to improve the diagnostic accuracy of hysteroscopy and reach the final diagnosis in AUB and is the subject matter of this study.
Methods: A prospective cross-sectional study was performed on 35 women with AUB, who presented to the Dept. of Obstetrics and Gynecology, JNMCH, Aligarh, over a period of 2 years (2014-2016). After transvaginal sonography, all cases underwent hysteroscopy followed by chromohysteroscopy using 5% methylene blue dye. Differentially stained pattern of the uterine cavity was observed and hysteroscopic guided biopsy was taken from stained and unstained areas, followed by endometrial aspiration biopsy. All three samples were sent for histopathological examination. Results were analyzed and compared.
Results: Out of 35 cases studied, 13 cases showed diffuse light staining, while 22 cases had focal dark staining. Histopathology results from diffuse light stained group showed 9 (69.2%) had normal endometrium. Out of 22 cases with focal dark staining, 20 (90.0%) cases had abnormal histopathology. It was found that focal dark staining to detect endometrial pathology had a sensitivity of 83.3%, specificity of 81.8%, positive predictive value of 90.9 %, negative predictive value of 69.2% and accuracy 82.8%. The difference in the diagnostic ability of stained tissue biopsy was highly significant (p< 0.001) when compared to blind endometrial aspiration biopsy.
Conclusions: Chromohysteroscopy is an efficacious simple tool for detecting endometrial pathology in cases of AUB.
Market Opinion and Research International (MORI). Women’s health in 1990. [Research study conducted on behalf of Parke-Davis Laboratories]. London:MORI ;1990.
Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. InSeminars Reproduct Med 2011;29(5):p. 383.
Vercellini P, Cortesi I, Oldandi S, Moschetta M, DeGiorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12(8):1768-71.
OJ Speroff Leon, Fritz MA. Clinical Gynaecologic endocrinology and infertility. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2011;591-604.
Kucuk T, Safali M. Chromohysteroscopy for evaluation of endometrium in recurrent in vitro fertilization failure. J Assist Reprod Genet. 2008;25(23):79-82.
Mansoura H, Mohamed A., Value of endometrial dyeing in diagnosis of endometritis in absence of macroscopic abnormalities during hysteroscopy. Middle East Fertil Soc J.2011;16(1):83-6.
Singh N, Singh B. Chromohysteroscopy—A new technique for endometrial biopsy in Abnormal Uterine Bleeding (AUB). Open J Obstet Gynecol. 2013;3(05):11.
El-Faissal, Yahia M., Ahmed M.Kamel.The Value of Chromohysteroscopy in Assessment of Postmenopausal Vaginal Bleeding. J Clinic Gynecol Obstet. 2014;3(1):35-41.
Bettochi S, Selvaggi L. A vaginoscopic approach to reduce pain of office hysteroscopy. J Am Assoc Gynecol Laparosc. 1997;4(2):255-8.
Jansen FW, Vredevoogd CB, Van Ulzen K, Hermans J, Trimbos JB, Trimbos, Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol.2000;96(2):266-70.