Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

A STUDY ON CONCORDANCE BETWEEN HYSTEROSCOPIC IMPRESSION AND ENDOMETRIAL HISTOPATHOLOGICAL DIAGNOSIS.

Author

David Engyeow Gan 1 , Rosy Jawan 1 , Moy Foong Ming 2

Institution

1 Department of Obstetrics and Gynecology, University of Malaya Medical Centre, Malaysia.
2 Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya

Abstract

Objectives: To evaluate the accuracy of hysteroscopic impression against histopathological diagnosis, and concordance between the two methods.

Methods: A retrospective analysis involving patients who undergone hysteroscopy with diagnostic dilatation and curettage at University of Malaya Medical Centre between January 2007 and August 2011. Demographic data for 500 patients was recorded and 88 were subsequently excluded due to inconclusive diagnosis. With 412 subjects, sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of hysteroscopy were calculated with their 95% confidence intervals. Histology results of the curettage specimens were considered the ‘gold standard’ and compared with hysteroscopic impression.

Results: Hysteroscopic view and histology results were concordant in 366(88.8%) subjects. Sensitivity, specificity, PPV and NPV were generally high ranging from 87.6% to 100%. However, there was a low sensitivity for endometrial hyperplasia (64.4%; 95% CI: 48.7-77.7%). Reduced PPV were observed for leiomyomata (83.3%; 95% CI: 57.7- 95.6%), endometrial hyperplasia (82.9%; 95% CI: 65.7-92.8%) and malignancy (62.1%; 95% CI: 42.4- 78.7%). This is attributed to tendency to misdiagnose hyperplasia as malignancy on hysteroscopy and weakness of curettage in detecting leiomyomata.

Conclusion: Hysteroscopy is an accurate diagnostic tool for benign and malignant endometrial pathology. However, endometrial sampling is recommended for all cases especially when hyperplasia or malignancy is suspected.