The diagnosis of endometrial atypia by hysteroscopy with guided biopsy in postmenopausal patients with hyperplasia: a reliable practice?

This study assesses the accuracy of histological diagnosis of endometrial atypia in hysteroscopy with blind biopsy, in postmenopausal women with an endometrial thickness (ET) greater than 5  mm. In order, to determine the relationship between ET and atypia more precisely, ET was subdivided in three categories of 5–7 mm, ≥7–9 mm and>9  mm. Ninety-nine postmenopausal patients, aged 51–79 years, with abnormal uterine bleeding and an endometrial thickness>5  mm in whom a diagnosis of endometrial hyperplasia, with or without atypia, was established with hysteroscopy with biopsy, underwent subsequent hysterectomy. Hysteroscopy and biopsy were carried out using a blind endometrial biopsy guided by hysteroscopic findings. The results of biopsies and hyste rectomy histology, for the presence of atypia, were compared. Sensitivity and likelihood ratio of hysteroscopic biopsy, as a diagnostic tool for detecting atypia, were calculated. The sensitivity in detecting atypia was 93.3 % corresponding to a negative likelihood ratio equal to 0.06. Univariate a nalysis did not show a significant association between atypia, age and/or endometrial thickness. The high sensitivity of hysteroscopic biopsy, corresponding to a strong negative likelihood ratio, made it a valid diagnostic tool for detecting atypia in postmenopausal women with abnormal uterine bleed ing, hyperplasia and endometrial thickness>5  mm. There was no association between atypia and increase of endometria...

Source: Gynecological Surgery - October 21, 2016 Category: OBGYN Source Type: research