The role of hysteroscopy in the management of asymptomatic postmenopausal patients with suspicious ultrasound findings of the uterine endometrium - Correlation with sonographic and histologic findings

To date endometrial adenocarcinoma is the most common genital cancer in wom en. Patients usually present with vaginal bleeding. Only 10-20% of asymptom atic women are diagnosed as having endometrial adenocarcinoma. The ultrason ic parameters for suspected endometrial pathology are not well defined and are often based on the endometrial thickness (6-10 mm). Purpose: In this study our objective was to correlate hysteroscopic and pat hological findings in asymptomatic postmenopausal women with an endometrial thickness of greater than or equal to 6 mm. Patients and Methods: 209 women underwent the following procedures: vaginal ultrasound (5 MHz probe), continuous flow hysteroscopy (4.5 mm Storz hyste roscope), and curettage of the uterine cervix and corpus (D & C). Results: Mean age was 66.2 +/- 7.6 years. Average endometrial thickness mea sured by ultrasound was 12.7 +/- 6.5 mm (range 6-45 mm). Hysteroscopy sugge sted endometrial polyps in 149 women (71.3%), simple focal endometrial hype rplasia in 3 patients, atrophic endometrium in 14 women, endometrial hyperp lasia in 29 patients (13.9%), myoma in 6 women. In 8 patients (3.8%) the hy steroscopic aspect was suspicious for malignancy and histology revealed end ometrial adenocarcinoma. The results of hysteroscopic examination were conf irmed by the histological findings. Conclusion: If suspicion is raised and further clarification is demanded, h ysteroscopy is an easy, safe and effective method. Considering the high num ber of endometrial polyps hysteroscopy increases the efficiency of D & C an d minimises the number of false negative procedures.