Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium

The goal of this study was to define the diagnostic value of hysteroscopy in evaluating uterine cavity compared to endometrial biopsy in women presenting with postmenopausal bleeding and thick endometrial mucosa with particular attention to endometrial hyperplasia and carcinoma. Eighty-three consecutive women presenting with postmenopausal bleeding and endometrial thickness of 5 mm or more measured by transvaginal ultrasound (TVU) were enrolled in a prospective study between May 2008 and July 2010. They underwent diagnostic hysteroscopy and endometrial biopsy. Hysteroscopic data was compared with the final diagnosis established by histological examination. The women's mean age was 61.2 +/- A 5.2 years (range 44-80). The most frequent endometrial lesion was endometrial polyps (31.1\%). Hyperplastic endometrium was confirmed in 23 (27.8\%), only 13 cases were suspected by the hysteroscope. Out of the 14 (16.9\%) proven cases of endometrial cancer, only half of the cases were suspected. In benign endometrial lesions, the sensitivity of the hysteroscopic view was 94.7\%, specificity was 97.8\%, positive (PPV) and negative (NPV) predictive values were 97.3 and 95.7\%, respectively. On the other hand, hysteroscopy demonstrated an overall sensitivity, specificity, PPV, and NPV of 56.5, 91.6, 72.2, and 84.6\%, respectively, in endometrial hyperplasia, whereas the same parameters for endometrial cancer were 50, 94.2, 63.6, and 90.2\%. Hysteroscopy can be used as the first line diagnostic tool for evaluating the benign endometrial lesions, such as endometrial polyp and submucosal myoma, nonetheless hysteroscopy has poor validity for excluding endometrial hyperplasia and cancer in women presenting with the postmenopausal bleeding and thick endometrium.