Comparison of hysteroscopy and histopathology in diagnosing abnormal uterine bleeding: an experience from a tertiary care center of eastern India

Abstract

Background: About one third of gynecological consultations are from abnormal uterine bleeding (AUB) in eastern India. In most of the cases, it remains as transient condition and cured by conservative medications but few of them require endometrial biopsy for definitive diagnosis to formulate treatment. Objectives: To find out the common uterine abnormality and to determine the validity and agreement of findings by hysteroscopy with histopathological findings. Methods: This observational study was conducted upon 150 women, who were selected consecutively from outpatient department of a tertiary care hospital of West Bengal from July, 2019 to December, 2019. Women with history of abnormal uterine bleeding for more than six months durations, and who required hysteroscopy directed endometrial tissue sampling for histopathological diagnosis comprised our study subjects. Hysteroscopy findings were compared to histopathological findings by means of sensitivity, specificity, positive predictive value, negative predictive value, and kappa. Results: Mean age of subjects was 39.68±6.19 years and commonest symptom and histopathology finding were menorrhagia (33.3%) and proliferative endometrium (25.3%) respectively. Endometrial thickness of 5-10 mm was the commonest (68.67%) by transvaginal sonography. The sensitivity, specificity, positive predictive value and negative predictive value were 96%. 53.8%, 90.9% and 77.8% respectively for detecting overall abnormal pathology by hysteroscopy in comparison to histopathology. Histopathological findings were comparable with hysteroscopy findings. Conclusions: For abnormal uterine bleeding, hysteroscopy can be a better tool for collecting proper sample for histopathological test while dilatation and curettage is a blind procedure. Accuracy in diagnosis helps to formulate better treatment protocol and to avoid unnecessary hysterectomies.

Keywords

• abnormal uterine bleeding
• endometrial curettage
• hysteroscopy