| Postmenopausal uterine bleeding (PMUB) can be defined as uterine bleeding occurring at least one year after menopause, including taking hormone replacement therapy irregular bleeding. PMUB is one of the common symptoms of outpatients in older women. It has been reported that 80% of endometrial cancer cases occur in postmenopausal women. Of postmenopausal women with vaginal bleeding, 10%-15% have endometrial carcinoma. So, more and more perimenopausal health professionals pay attention to it. For the diagnosis methods of the cause of postmenopausal bleeding, there are dilation and curettage(D&C), hysteroscopy, abdominal ultrasound, transvaginal ultrasound(TVS), sonohysterography(SHG), computed tomography, magnetic resonance and so on. How to select the most appropriate method for diagnosing postmenopausal bleeding has always been the concern of the clinical gynecologists. Traditionally, ultrasound and D&C are confirmed as the gold standard in the diagnosis of postmenopausal bleeding. With the development of technology and application of endoscopic technology, hysteroscopy and directed biopsy has obviously increased the accuracy of etiological diagnosis and has been gradually accepted by modern gynecologists. Hysteroscopy has been confirmed as the gold standard in diagnosis of intrauterine lesions.ObjectiveThe aim of the study is to evaluate the clinical value of hysteroscopy in the diagnosis of postmenopausal uterus bleeding through the comparative analysis with diagnostic of hysteroscopy and D&C.MethodsThis retrospective study analyzed 129 cases of post-menopausal bleeding in which both a hysteroscopic and a D&C examination were taken from January 2009 to December 2010 at the Third Affiliated Hospital of Zhengzhou University. If necessary, the patients also had hysteroscopy biopsy. The results were compared with histopathological and hysteroscopic diagnosis of specimens obtained by hysterectomy, hysteroscopic surgery (hysteroscopic resection of endometrial polyps, hysteroscopic myomectomy, hysteroscopic endometrial resection), hysteroscopy biopsy drawn or D&C so as to evaluate the sensitivity, specificity, and predictive value of hysteroscopy and D&C in the diagnosis of postmenopausal uterine bleeding.ResultsHysteroscopy showed a sensitivity, specificity, positive predictive value and negative predictive values of 91.43%,95.74%,88.89%,96.77% respectively in diagnosing endometrial polyps; values of:83.33%,99.19%,83.33%,99.19% respectively in diagnosing submucous myoma; values of 46.15%,99.14%,85.71%, 94.26% respectively in diagnosing endometrial hyperplasia and values of 93.75%, 98.23%,88.23%,99.11% respectively in diagnosing endometrial cancer. On the other hand, D&C demonstrated a sensitivity, specificity, positive predictive value and negative predictive values of 54.28%,100%,100%,85.45% respectively in diagnosing endometrial polyps; values of:33.33%,100% 100%,96.85% respectively in diagnosing submucous myoma; values of 76.92%,93.1%,55.55%,97.29% respectively in diagnosing endometrial hyperplasia and values of 62.5%,100%,100%, 94.95% respectively in diagnosing endometrial cancer. Comparison of the two methods indicates the sensitivity and negative predictive value of hysteroscopy is better than D&C in diagnosis of endometrial polyps(P<0.01), the sensitivity of hysteroscopy is better than D&C in diagnosis of endometrial cancer(P<0.05), the specificity of hysteroscopy is better than D&C in diagnosis of endometrial hyperplasia (P<0.05). On the other hand, the specificity of D&C is better than hysteroscopy in diagnosis of endometrial polyps(P<0.05) and the positive predictive vaule of D&C is better than hysteroscopy in diagnosis of endometrial polyps(P <0.01).ConclusionHysteroscopy has a relatively high sensitivity and negative predictive value in diagnosing intrauterine lesions of postmenopausal uterine bleeding. Hysteroscopy in combination with direct biopsy scope can accurately diagnose endometrial cancer and makes up for the lack of D&C in diagnosing intrauterine lesions. |
PDF Full Text Request