Document Type : Research articles

Authors

• Yan Lei
• Xin Du
• Rong Zheng

Department of Gynecology, Hubei Maternal and Children's Hospital, Wuhan, China

Abstract

Background and Aims: Endometrial cancer is the most common type of reproductive system cancer. The present study aimed to investigate the diagnostic value of abnormal hysteroscopic findings in endometrial lesions.
Materials and Methods: In this retrospective cohort study, 669 cases with suspected endometrial lesions detected by B-scan ultrasonography were further examined using hysteroscopy. The biopsy results were considered the gold standard, and the diagnostic value of abnormal hysteroscopic findings and diagnostic efficacy of specific hysteroscopic findings in endometrial lesions were compared and analyzed. Moreover, the clinical features of the participants were evaluated.
Results: Among patients, the complete coincidence rate between diagnosis made by hysteroscopy and pathological diagnosis was 91.33% (611/669), and the Kappa value of the consistency test was 0.951 (2). Regarding the major abnormalities detected under hysteroscopy, the most common finding in patients with normal endometrium, validated by biopsy results, was irregular thickening of the endometrium. In patients with endometrial hyperplasia, validated by the biopsy results, abnormality of the blood vessel was the most common finding. However, it should be noted that the sensitivity was low. Abnormality of blood vessels was also the most common finding in patients with endometrial carcinoma. The sensitivity and positive predictive values (<50%) were low. (3) The age difference between patients with normal endometrium and endometrial hyperplasia was statistically significant (P<0.01). There was a statistically significant difference between the patients with normal endometrium and In cases with normal endometrium and endometrial lesions, the morbidity difference was statistically significant between the group of patients with either obesity or hyperlipidemia and the group without comorbidities (X2=231.253, P<0.01, X2=106.086, P<0.01). There was a statistically significant difference between patients with endometrial hyperplasia and those with endometrial cancer in terms of morbidity of obesity or hyperlipidemia (P=0.042).
Conclusion: Hysteroscopy has high accuracy and stable diagnostic efficiency in the diagnosis of endometrial diseases. Nevertheless, the diagnostic value of abnormal blood vessels seen under hysteroscopy is insufficient for the diagnosis of endometrial lesions. Therefore, it cannot be used as the sole criterion for the diagnosis of endometrial lesions. Patients with irregular thickening of the endometrium are more likely to have a normal endometrium, and such patients can avoid unnecessary biopsy if they have no other risk factors. Obesity and hyperlipidemia are significant independent risk factors for endometrial cancer.

Keywords

• Abnormal findings under hysteroscopy
• Endometrial lesions
• Hysteroscopy