Concordance between hysteroscopic impression and endometrial histopathological diagnosis
A partir de données administratives portant sur 412 patientes ayant subi une hystéroscopie avec dilatation cervicale puis curetage de l'utérus, cette étude transversale rétrospective analyse la corrélation entre les résultats de l'examen hystéroscopique et les résultats de l'analyse histopathologique des échantillons utérins prélevés
Objective To evaluate the accuracy of hysteroscopic impression for diagnosing benign and malignant endometrial pathology. Method A retrospective cross-sectional study involving case records of 412 patients who underwent hysteroscopy with diagnostic dilatation and curettage (D&C) at University Malaya Medical Centre from January 2009 to August 2011, and cases with records of previous hysteroscopies (2007–2008). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values; likelihood ratios (LR) and post-test probabilities of hysteroscopy were calculated. D&C was set as the ‘gold standard’. Results Hysteroscopy and histology results were concordant in 366(88.8%) subjects. Sensitivity, specificity, PPV and NPV were high exceeding 80%. Moderate sensitivity for endometrial hyperplasia (64.4%, 95% CI = 49.8%-76.8%) with moderate PPV for malignancy (62.1%, 95% CI = 44.0%-77.3%) due to misdiagnosing hyperplasia as malignancy. PPV for leiomyoma was reduced (83.3%, 95% CI = 60.8%-94.2%) despite 100% sensitivity, due to D&C false negatives. High positive LR (> 10) and low negative LR (< 0.2) was observed generally except for endometrial hyperplasia (0.36). Hysteroscopy had moderate positive post-test probability for malignancy (0.62) but effective in ruling out malignancy (negative post-test probability = 0.00). Conclusion Hysteroscopy is accurate for focal and malignant endometrial pathology but only moderate for hyperplasia. Endometrial sampling is recommended for all cases especially when suspecting hyperplasia or malignancy.
Preventive Medicine , résumé, 2012