Effectiveness of hysteroscopy in evaluation of abnormal uterine bleeding and its Histopathological correlations

The Study Objective: 1. To study the role of hysteroscopy in evaluation of abnormal uterine bleeding. 2. To correlate accuracy of hysteroscopic findings with histopathologic findings. Material and methods Designs: A retrospective study was done from from March 2014 to March 2016. Setting: study was carried out in the Department of Gynecological endoscopy at Manchanda’s Endoscopic Center, PSRI, Delhi Patients: One hundred and two cases were selected for this study from patients of age group 18 and above, who were admitted with the history of abnormal uterine bleeding. After detailed menstrual history, both systemic and gynecological examination was done. USG pelvis was done to detect any structural abnormality and to see the endometrial thickness. Patients were admitted on D5-D10 of their menstrual cycle except patients with grossly irregular cycles. In case of post-menopausal woman, they were prepared and admitted when the bleeding decreased or stopped. Interventions: All patients underwent hysteroscopy post-menstrually, whenever possible, except in cases where menstrual cycles were grossly irregular.endometrial biopsy was taken at the same sitting during hysteroscopy and sent for histopathology. The correlation between findings on hysteroscopy and histopathological examination was tabulated and analyzed. Result: In our study we found that hysteroscopy serves as good tool with sensitivity of 87.5% in diagnosing intrauterine pathology. It also has high specificity of 91.3%. It has positive predictive value of 92.5% and negative predictive value of 85.7% .It was accurate in diagnosing pathology in 89.2% of patients with AUB with significant p value when compared to histopathology which is the gold standard. All the findings had significant p value. Conclusion: Hysteroscopy is highly sensitive and accurate tool for diagnosis in patients with AUB. Due to direct visualization, pathologies like endometrial polyp, submucous myoma, carcinoma endometrium, atrophic endometrium, retained products and hyperplasia can be diagnosed with great precision. Hysteroscopy with directed biopsies should be preferred over traditional dilatation and curettage for its advantages like direct visualization of pathology, reduced hospital stay, less surgical trauma and accuracy.