الفهرس 
HysteroscopyOnly 14 pages are availabe for public view
 |  | from | 130 |  |  |
| | | from | 130 | | |
Abstract
Postmenopausal state is considered established after one
year of amenorrhea above 45 years. Any vaginal bleeding
following one year amenorrhea or more from the date of last
menstrual period is called postmenopausal bleeding (PMB).
Any woman who is still menstruating after 55 years should be
viewed with suspicion and postmenopausal blood stained
discharge has equal significance to that of PMB.
PMB must be considered as a symptom and not a
diagnosis. Moreover, it must be regarded as a symptom of
genital tract malignancy until proved otherwise.
The direct view of the uterine cavity afforded by
hysteroscopy offers a significant advantage over the other
methods such as hysterosalpingography, dilatation and
curettage, endometrial biopsy and ultrasound, as these other
modalities offer only a blind or indirect view of the cavity. At
hysteroscopy, lesions can be clearly identified and their location
and size accurately determined and tissue samples can be
obtained for pathological examination
In fact, some have advocated hysteroscopy as the primary
tool for the diagnosis of PMB. Although it is highly accurate
for identifying endometrial cancer, it is less accurate for
endometrial hyperplasia. Thus, some recommend endometrial
biopsy or endometrial curettage in conjunction with
hysteroscopy.
Moreover, the success of hysteroscopy depends on
appropriate selection of the patient, the absence of
contraindications, adequate instrumentation and meticulous
technique.
Today diagnostic hysteroscopy can be considered the
optimal method of assessing all cases where visualizing the
cervical canal, uterine cavity and tubal ostea will improve
diagnostic accuracy and guide therapeutic management. It is in
the field of improved diagnosis that hysteroscopy has made the
most significant progress, mainly because the ability to use fine
diameter instruments makes it feasible to avoid both
anaesthesia and cervical dilatation. The procedure may
therefore be performed in an outpatient setting without the need
for hospitalization.
The use of diagnostic hysteroscopy in the management of
PMB may, in many instances, replace procedures such as D&C.
The magnifying power of the microhysteroscope and its ability
to penetrate the cervical canal to regions inaccessible to the
colposcope suggest a very real role in the assessment of
precancerous and cancerous lesions of the endometr
Hysteroscopy is no longer a ”procedure looking for an
indication”.
The aim of the present study is to estimate the accuracy of
hysteroscopy in predicting endometrial histopathology in cases
of postmenopousal bleeding.
The mean age of 657 women participating in the study
was 50+6 years (range 44–86 years) and they were
postmenopausal for an average of 11.6 ± 8.4 years (range 1–31
years).
Endometrial polyps was the most common hysteroscopic
pathologies observed in 130 (19.70%), this result was
overestimated as only 66 cases of endometrial polyps
confirmed by histopathology, the remaining 64 cases ( 32 of
them confirmed normal variants of endometrium, 16 confirmed
endometritis, and 16 cases diagnosed as endometrial
hyperplasia).
We had exelent result regarding hysteroscopic prediction
of cancer, as all the 86 (13.13%) cases that were confirmed by
histology, were suspected by hysteroscopy, in addition seven
cases diagnosed as cancer by hysteroscopy but confirmed to be
endometrial hyperplasia by histopathology.
While endometrial hyperplasia diagnosed visually by the
hysteroscopist in 66 (10.10%). The hysteroscopic findings an
the histological diagnoses were compared in 657 cases. Of note,
hyperplastic endometrium was confirmed by histology in 100
(15.15%), 66 cases had been suspected by the hysteroscope, the
other 34 cases were not suspected during visual diagnosis of the
uterine cavity, (16 diagonsed by fault as endometrial polyps , 7
diagonsed as endometrial cancer , 6 as myomas).
The seven myomas at hysteroscopy were confirmed by
biopsy, in addition six cases diagnosed by fault as myomas and
confirmed to be hyperplastic polyps in histology reports.
In cases of normal endometrium
Hysteroscopy has a sensitivity of (89%), specificity
(100%) and accuracy (94.9%).
In cases of abnormal endometrium
Hysteroscopy has a sensitivity of (83.6%), specificity
(77.7%) and accuracy (91.4%).
In cases of endometrial hyperplasia
Hysteroscopy has a sensitivity 66.67%, specificity
100.00%, and accuracy (94.9%).
In cases of Endometrial polyps
Hysteroscopy has a sensitivity100%, specificity89.33%,
and accuracy (90.4%)
In cases of cancer
Hysteroscopy has a sensitivity100%, specificity98.84%,
and accuracy (98.9%).
In cases of atrophic endomertrium:
Hysteroscopy has a sensitivity of (100%), specifcity
(98.95%) and accuracy (98.98%).
In cases of myomas
Hysteroscopy has a sensitivity (100.00%),
specificity(89.98%), and accuracy (92.3%).
Outpatient hysteroscopy was a feasible and welltolerated
technique. All women for whom cervical stenosis and
hysteroscopy could not be performed were excluded. We did
not report adverse experiences, such as uterine perforation or
failure to visualize the uterine cavity during the performance of
all the hysteroscopies.
Using pathologic diagnoses as gold standard, the
calculated sensitivity, specificity, PPV, and NPV showing good
hysteroscopic performance in visual diagnosis of cancer and the
overall uterine cavity abnormality. However, the same
parameters showing its limited value for the detection of
endometrial hyperplasia.