VALIDITY OF HYSTEROSCOPY AND HISTOPATHOLOGY IN PATIENTS WITH MENSTRUAL IRREGULARITY
Abstract
Background: Abnormalities in menstrual cycle is the most common presenting symptom inGynaecology out-patient. Dilatation and curettage has been the diagnostic investigation of choicefor decades in such cases. With the advent of new more valid and safe methods, it has beenreplaced by hysteroscopy as gold standard. The objective of this study was to know the sensitivityand specificity of hysteroscopy in patients presenting with menstrual irregularity. Methods:Validity study was conducted over 269 cases for a period of two years at Maternal and child healthcentre, Pakistan Institute of Medical Sciences, Islamabad. Inclusion criteria were age ≥35 yearsand abnormal uterine bleeding. Patient with positive pregnancy test, recent cervicitis, vaginitis,endometritis, pelvic infection were excluded. Hysteroscopy and curettage was performed aftertaking informed consent, mostly on outpatient basis. A predesigned Performa was used for adetailed record of hysteroscopic findings, which were later compared with histopathology report.Data was analysed using MS Excel, and Cross Tabulation was done using Epi-info. Sensitivity,specificity, positive predictive value and negative predictive value of hysteroscopy was calculatedagainst histopathology, the gold standard. Results: Sensitivity, specificity, positive predictivevalue and negative predictive value of hysteroscopy was calculated against histopathology afterexcluding 46 (17.1%) cases of uterine fibroid that were diagnosed only at hysteroscopy.Hysteroscopy has shown highest sensitivity for retained products of conception andadenocarcinoma (100%) while a specificity of 90% and above for all hysteroscopic findings.Seventy eight percent of the procedures were performed on outpatient basis, 95% underintravenous sedation and 95% with no operative complication. Conclusion: Hysteroscopy shouldbe used as an adjunct procedure to curettage as it is a better tool for diagnosis of intracavitylesions, with a high sensitivity and specificity for endometrial carcinoma.Keywords: Hysteroscopy, histopathology, menstrual irregularityReferences
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