Diagnostic fibrohysteroscopic evaluation of perimenopausal and postmenopausal uterine bleeding: A comparative study with Belgian and Japanese data |
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| Institution: | 1. Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Greece;2. Department of Oral and Maxillofacial Surgery, “Evaggelismos” General Hospital, National and Kapodistrian University of Athens, Greece;3. Department of Oral Pathology, Faculty of Dentistry, Chulalongkom University, Bangkok, Thailand;4. Department of Pathology, Medical School, National and Kapodistrian University of Athens, Greece;1. The Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan 646000, China;2. Department of Plastic Surgery, Shanghai 6th People''s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200237, China;1. Department of Critical Care, Regina General Hospital, Regina, Saskatchewan, Canada;2. Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;3. Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;4. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada;5. Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada;6. Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada;7. Liver Transplant Program, Alberta Health Services, Edmonton, Alberta, Canada |
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| Abstract: | The most appropriate hysteroscope is the smallest that allows one to perform a biopsy. We use a 3.5- or 4.9-mm Olympus flexible hysteroscope with a failure rate below 3% for office or hospital ambulatory procedures without anesthesia or cervical dilatation. In postmenopausal women (with no hormone treatment) with uterine bleeding, we do not perform hysteroscopy if vaginal sonography detects endometrial thickness less than 4 mm. At this cut-off limit the calculated risk for not detecting an endometrial abnormality is 5.5%. In al other patients we prefer fibrohysteroscopy because its diagnostic accuracy is higher than that of vaginal ultrasound, vaginal ultrasound can easily miss a focal lesion of hyperplasia or adenocarcinoma incipiens, and abnormal endometrial findings detected by vaginal ultrasound or sonohysterography require directed biopsy during hysteroscopy. A comparative study evaluated the experience in our two series (286 patients), a Belgian report (251), and a Japanese report (444). Apart from myoma, 50% of findings were atrophic normal endometrium, and concordance was good for detecting adenocarcinoma (±3%). The results suggest using the fibrohysteroscope rather than the rigid scope because of its excellent accuracy. |
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