A Comparison of Visual Findings at Hysteroscopy with Endometrial Biopsy Histology among Women Being Investigated for Postmenopausal Bleeding

J. Mamah, A. Onyebuchi, Zubaida Abubakar-Aliyu, Nnaemeka Egbuonu, Obinna Oraekwe
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Abstract

Between 90-95% of patients diagnosed with endometrial cancer present with postmenopausal bleeding. Hysteroscopy and endometrial biopsy are vital tools in the investigation of women with postmenopausal bleeding. Accurate interpretation of visual findings during hysteroscopy is an important requirement in the diagnosis and management of PMB. We undertook an audit of findings of hysteroscopies performed on women with postmenopausal bleeding and compared with histology report of endometrial biopsy taken during the hysteroscopy. Findings will be used to improve service delivery. A retrospective review was conducted between July 2019 to December 2019. Structured proforma was used for anonymised data collection and entered into an excel spreadsheet of the 2018 version. Descriptive statistical analysis was followed to determine frequencies and percentages. Accuracy of hysteroscopic findings was measured against endometrial biopsy histology report. A total of 133 patients referred for postmenopausal bleeding met the criteria for hysteroscopy and endometrial biopsy. The mean age of the participants was 60 years. The overall accuracy of hysteroscopic visual diagnosis of endometrial pathology was 75.0%. The sensitivity and specificity were 80.0% and 88.0%, while the positive predictive value (PPV) and negative predictive value (NPV) were 66.7%, and 93.8% respectively. Specificity and NPV were 100% and 93.8% for endometrial cancer, which was diagnosed in 7.5% of the patients. In conclusion, we found that compared with histologic diagnosis, three quarter of the women with histology confirmed endometrial pathology were correctly identified during hysteroscopy. Hysteroscopy had a high specificity and negative predictive value in excluding endometrial cancer. There is room for more training and skills enhancement.
绝经后出血妇女宫腔镜视觉表现与子宫内膜活检组织学比较
90-95%诊断为子宫内膜癌的患者存在绝经后出血。宫腔镜和子宫内膜活检是调查绝经后出血妇女的重要工具。准确解释宫腔镜下的视觉表现是诊断和治疗PMB的重要要求。我们对绝经后出血妇女的宫腔镜检查结果进行了审计,并与宫腔镜检查期间子宫内膜活检的组织学报告进行了比较。调查结果将用于改善服务提供。在2019年7月至2019年12月期间进行了回顾性审查。结构化形式用于匿名数据收集,并输入2018年版本的excel电子表格。采用描述性统计分析确定频率和百分比。宫腔镜检查结果的准确性与子宫内膜活检组织学报告相对照。共有133例绝经后出血患者符合宫腔镜和子宫内膜活检的标准。参与者的平均年龄为60岁。宫腔镜对子宫内膜病理诊断的总体准确率为75.0%。敏感性和特异性分别为80.0%和88.0%,阳性预测值(PPV)和阴性预测值(NPV)分别为66.7%和93.8%。子宫内膜癌的特异性为100%,NPV为93.8%,诊断率为7.5%。总之,我们发现与组织学诊断相比,四分之三的组织学证实子宫内膜病理的妇女在宫腔镜检查中被正确识别。宫腔镜在排除子宫内膜癌方面具有高特异性和阴性预测值。还有更多培训和技能提升的空间。
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