The efficacy of outpatient hysteroscopy in the diagnosis and treatment of endometrial pathology
Sathish C.
The efficacy of outpatient hysteroscopy in the diagnosis and treatment of endometrial pathology - 2015
NMUH Staff Publications EMBASE 122
<span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">Introduction Outpatient hysteroscopy enables the identification and more recently, the treatment of uterine pathologic disorders in the ambulatory setting. Thanks to advances in instrumentation, allowing better comfort for patients, outpatient hysteroscopy is now widely used as the first line uterine investigation as opposed to hysteroscopy under general anaesthetic. The indication for hysteroscopy, however, is often guided by pelvic ultrasound findings. Methods We conducted a retrospective study of 83 patients undergoing outpatient hysteroscopy between January 2014 and March 2014, looking at the indication for hysteroscopy, its feasibility and complications and we compared pelvic ultrasound findings prior to hysteroscopy to both hysteroscopic findings and histopathological outcomes. Results The average age was 47 years (range 28-76 years), of which 27 (32%) were menopausal. The referral causes were: hyperplasia on the ultrasound examination (4 cases), postmenopausal bleeding (23 cases), menorrhagia (26 cases), infertility (10 cases), polyps on ultrasound scan (3 cases) and IUD retained (4 cases), intermenstrual bleeding (11 cases) and recurrent miscarriages (2 cases). Concordance between hysteroscopy diagnosis and histopathological findings was 65%. There were 13% cases of impaired visualisation of the uterine cavity, either for cervical stenosis or excessive pain. 25% of patients were referred for hysteroscopy under general anaesthetic. A normal uterine cavity was attained in 25 cases (30%). Out of the women who presented with PMB and ET >4 mm, the common hysteroscopy findings were that of endometrial polyps consistent with benign histopathology. 2 of the 26 women had histology consistent with endometrial cancer (ET > 10 mm). Among the perimenopausal group (45-55 years), the commonest USG finding was multiple fibroids and outpatient hysteroscopy findings were normal uterine cavity with no polyps or fibroids consistent with dysfunctional uterine bleeding. The commonest operative procedure was MIRENA IUS insertion. Conclusion This study demonstrates that in a carefully selected pre-menopausal group, there is still place for Pipelle endometrial sampling and MIRENA IUS insertion in the general gynaecology outpatient setting rather than hysteroscopy. 25% of our patients were sent for further hysteroscopy under a day surgery setting, with no clear differentiating features on ultrasound scan:10 (48%) of whom had ET < 4 mm, 6 (29%) had ET 4-10 mm and 5 (24%) had ET > 10 mm. Although outpatient hysteroscopy is considered generally safe and cost-effective compared to daycase hysteroscopy procedure, this should be reserved for women with PMB and the high risk premenopausal groups.</span> [Conference Abstract]</span>
The efficacy of outpatient hysteroscopy in the diagnosis and treatment of endometrial pathology - 2015
NMUH Staff Publications EMBASE 122
<span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">Introduction Outpatient hysteroscopy enables the identification and more recently, the treatment of uterine pathologic disorders in the ambulatory setting. Thanks to advances in instrumentation, allowing better comfort for patients, outpatient hysteroscopy is now widely used as the first line uterine investigation as opposed to hysteroscopy under general anaesthetic. The indication for hysteroscopy, however, is often guided by pelvic ultrasound findings. Methods We conducted a retrospective study of 83 patients undergoing outpatient hysteroscopy between January 2014 and March 2014, looking at the indication for hysteroscopy, its feasibility and complications and we compared pelvic ultrasound findings prior to hysteroscopy to both hysteroscopic findings and histopathological outcomes. Results The average age was 47 years (range 28-76 years), of which 27 (32%) were menopausal. The referral causes were: hyperplasia on the ultrasound examination (4 cases), postmenopausal bleeding (23 cases), menorrhagia (26 cases), infertility (10 cases), polyps on ultrasound scan (3 cases) and IUD retained (4 cases), intermenstrual bleeding (11 cases) and recurrent miscarriages (2 cases). Concordance between hysteroscopy diagnosis and histopathological findings was 65%. There were 13% cases of impaired visualisation of the uterine cavity, either for cervical stenosis or excessive pain. 25% of patients were referred for hysteroscopy under general anaesthetic. A normal uterine cavity was attained in 25 cases (30%). Out of the women who presented with PMB and ET >4 mm, the common hysteroscopy findings were that of endometrial polyps consistent with benign histopathology. 2 of the 26 women had histology consistent with endometrial cancer (ET > 10 mm). Among the perimenopausal group (45-55 years), the commonest USG finding was multiple fibroids and outpatient hysteroscopy findings were normal uterine cavity with no polyps or fibroids consistent with dysfunctional uterine bleeding. The commonest operative procedure was MIRENA IUS insertion. Conclusion This study demonstrates that in a carefully selected pre-menopausal group, there is still place for Pipelle endometrial sampling and MIRENA IUS insertion in the general gynaecology outpatient setting rather than hysteroscopy. 25% of our patients were sent for further hysteroscopy under a day surgery setting, with no clear differentiating features on ultrasound scan:10 (48%) of whom had ET < 4 mm, 6 (29%) had ET 4-10 mm and 5 (24%) had ET > 10 mm. Although outpatient hysteroscopy is considered generally safe and cost-effective compared to daycase hysteroscopy procedure, this should be reserved for women with PMB and the high risk premenopausal groups.</span> [Conference Abstract]</span>