Hysteroscopic Findings in Postmenopausal Bleeding and its Correlation with Histopathology: Does Clinical Experience Matter?

Abstract
Background: women with PMB have a 10–15% chance of having endometrial carcinoma. Therefore, prompt and accurate evaluation to exclude malignant or premalignant lesions of the endometrium is necessary
Aim: To evaluate different hysteroscopic findings in women with PMB and its correlation with histopathological finding in early and late postmenopausal women.
Methods: This retrospective observational study was carried out in early cancer detection unit (ECDU) in Ain Shams University Maternity Hospital between June 2017 and December 2017 involving medical records of 83 women presented with PMB who underwent hysteroscopy and endometrial sampling. We identified hysteroscopic appearance of the endometrium and any focal lesion then the findings were later correlated with the final histopathological diagnosis.
Results: the commonest hysteroscopic appearance of the endometrium was thick hypertrophic endometrium (59.6% in early postmenopausal years group A and 61.5% in late postmenopausal years group B). Benign pathology was observed in 50 women (87.7%) in group A and in14 women (53.8%) in group B, malignant and premalignant lesions were found in 7% and 30.8% respectively. Inadequate samples occurred in 5.3% and 15.4% of women in group A and B respectively. Hysteroscopic sensitivity in detecting malignant lesions was 83.3%, while its Specificity was 96.87%
Conclusions: Hysteroscopy is an accurate and reliable method for diagnosing endometrial cancers, and offers a good immediate therapeutic option for women with obvious benign lesions as endometrial polyp. There is no difference in hysteroscopic accuracy in detecting malignancy with different operators’ clinical experiences.