DIAGNOSTIC FIBROHYSTEROSCOPIC EVALUATION OF PERIMENOPAUSAL AND POSTMENOPAUSAL UTERINE BLEEDING - A COMPARATIVE-STUDY WITH BELGIAN AND JAPANESE DATA

The most appropriate hysteroscope is the smallest that allows one to p erform a biopsy. We use a 3.5- or 4.9-mm Olympus flexible hysteroscope with a failure rate below 3% for office or hospital ambulatory proced ures without anesthesia or cervical dilatation. In postmenopausal wome n (with no hormone treatment) with uterine bleeding we do not perform hysteroscopy ii vaginal sonography detects endometrial thickness less than 4 mm. At this cut-off limit the calculated risk for not detecting an endometrial abnormality is 5.5%. In all other patients we prefer f ibrohysteroscopy because its diagnostic accuracy is higher than that o f vagina I ultrasound, vaginal ultrasound can easily miss a focal lesi on of hyperplasia or adenocarcinoma incipiens, and abnormal endometria l findings detected by vaginal ultrasound or sonohysterography require directed biopsy during hysteroscopy. A comparative study evaluated th e experience in our two series (286 patients), a Belgian report (251), and a Japanese report (444). Apart from myoma, 50% of findings were a trophic normal endometrium, and concordance was good ibr detecting ade nocarcinoma (+/-3%). The results suggest using the fibrohysteroscope r ather than the rigid scope because of its excellent accuracy.