Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction

Study Objectives. To review diagnoses, complications, and surgical findings in women treated for abnormal uterine bleeding by operative hysteroscopy, and to assess the accuracy of preoperative transvaginal ultrasound (TVS), s aline-infusion sonography (SIS) diagnostic hysteroscopy, and endometrial bi opsy. Design. Retrospective study (Canadian task force classification II-2). Setting. Tertiary care academic medical center. Patients, Three hundred seventy-five women. Intervention. Operative hysteroscopy for abnormal uterine bleeding. Measurements and Main Results, Main indications for hysteroscopy were postm enopausal bleeding (164 patients, 43.7%) and abnormal premenopausal uterine bleeding (211, 56.3%). Main pathology findings were endomefrial polyps (17 2, 45.9%) and submucous myomas (105, 28%). Polyps had histologic abnormalit ies in 18 patients. Sensitivity of preoperative diagnostic tools for all in trauterine abnormalities and specifically for myomas and polyps was TVS 74% and 39%, SIS 96% and 96%, hysteroscopy 100% and 99%, and Pipelle biopsy 24 % and 10%. The complication rate was 1.3%. Postmenopausal women felt signif icantly more improvement in symptoms (p = 0.02), and were more satisfied (p less than or equal to 0.001) than premenopausal women. Only 10 women had r epeat surgery for the problem. Conclusion. Operative hysteroscopy is a safe outpatient procedure and is as sociated with high satisfaction in carefully selected patients. Hysteroscop y and SIS are better diagnostic tests for intracavitary abnormalities than TVS and endometrial biopsy.