The efficacy of hysteroscopy for endometrial pathology: the experience of a university clinic on diagnostic accuracy and the comparison with the other methods

Hysteroscopy procedures were retrospectively reviewed in order to reveal the diagnostic accuracy and the efficiency of the diagnostic procedures (transvaginal ultrasonography/TvUsg, saline infusion sonography/SIS, hysteroscopy) for an educational institution in the management of abnormal uterine bleeding. The study was completed in the Department of Gynecology and Obstetrics of the Istanbul University Cerrahpasa School of Medicine by reviewing the hospital records of the patients on whom hysteroscopy had been performed between 1 January 1997 and 31 December 2002. The records of 385 patients were eligible. The sensitivity, specificity and positive and negative predictive values for saline infusion sonography and hysteroscopy were calculated for specific histopathological diagnoses. The sensitivity and specificity of hysteroscopy for the detection of endometrial polyps were calculated as 83.9 and 63.0%, respectively. The positive predictive value (PPV) was 74.6% and negative predictive value (NPV) 75.2%. The sensitivity and specificity of saline infusion sonography for the detection of endometrial polyps were found to be 87.2 and 33.3%, respectively. PPV was 71.4% and NPV was 57.6% for SIS. The sensitivity and specificity of hysteroscopy for the detection of submucosal leiomyoma were determined to be 80.0 and 92.4%, respectively. PPV was 43.2% and NPV was 98.0%. The sensitivity and specificity of SIS for the detection of submucosal leiomyoma were 71.4 and 92.3%, respectively. PPV was calculated as 52.6% and NPV as 75.2% for SIS. Due to its high diagnostic accuracy and lower complication rate even in the educational setting, we believe that hysteroscopy will retain its place as the “gold standard” procedure for the investigation of endometrial pathology.