DIAGNOSTIC-ACCURACY OF HYSTEROSCOPY IN ENDOMETRIAL HYPERPLASIA

Objectives: To determine the diagnostic accuracy of hysteroscopy in th e diagnosis of endometrial hyperplasia in women with abnormal uterine bleeding. Methods: From 1993 through 1995, 980 women referred to our: institution for abnormal uterine bleeding underwent diagnostic hystero scopy with eye direct biopsy of the endometrium in case of macroscopic abnormalities. Hysteroscopic features were compared with pathologic f indings in order to detect the reliability of the endoscopic procedure . Statistical analysis was performed with the McNemar test. Results: P ositive predictive value of hysteroscopy in the diagnosis of endometri al hyperplasia accounted for 63%. In fact hysteroscopic diagnosis of e ndometrial hyperplasia was confirmed at pathologic examination in 81 o ut of 128 patients. Sensitivity and specificity of the endoscopic proc edure accounted for 98% and 95%, respectively. Negative predictive val ue accounted for 99%, as only two cases of atypical hyperplasia were m issed at hysteroscopy. Positive predictive value was higher in postmen opausal patients compared to women in the fertile age (72 vs. 58%). Co nclusions: Overall, results appear encouraging, since no case of endom etrial hyperplasia was missed by hysteroscopy. The high diagnostic acc uracy, associated with a minimal trauma, renders hysteroscopy the idea l procedure for both diagnosis and follow-up of conservative managemen t of endometrial hyperplasia.