Evaluation of Hysteroscopic Findings and Histopathologic Report of Endometrium in Postmenopausal Bleeding

Abstract

Background: Women with postmenopausal bleeding have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic work is aimed at excluding uterine malignancy. For accurate diagnosis of cause of postmenopausal bleeding, endometrial abnormalities can be assessed by hysteroscopy and hysteroscopy directed biopsy or fractional curettage. Objective: To compare the hysteroscopic findings with histopathologic report of endometrium in postmenopausal bleeding. Methods: Cross sectional study was conducted in the department of gynaecological oncology in Bangabandhu Sheikh Mujib Medical University over 1 year from June 2019 to May 2020. Thirty women with the complaints of postmenopausal bleeding were enrolled.   Each women underwent hysteroscopic evaluation and endometrial tissue was obtained by hysteroscopy directed biopsy as well as fractional curettage in some cases, then sent for histopathology. Results were analyzed to find out sensitivity, specificity, accuracy, positive predictive value and negative predictive value of hysteroscopy, taking histopathological diagnosis as gold standard. Analysis was carried out by using SPSS version 26. Results: Hysteroscopic examination findings and histopathology of endometrium in 30 postmenopausal women, 11(36.6%) cases were found normal both on hysteroscopy and histopathology, among them 4(13.3%) cases were proliferative endometrium, 1(3.3%) was secretory endometrium and 5(16.6%) cases were found atrophic endometrium and 1(3.3%) tissue was insufficient. Hysteroscopic view of normal endometrium showed a sensitivity 100%, specificity 100%, positive predictive value 100%, negative predictive value 100% and accuracy 100%. For Endometrial polyp showed sensitivity, specificity, positive predictive value, negative predictive value   and accuracy 100%respectively. For Hyperplasia, hysteroscopy showed sensitivity 100%, specificity 96.2%, positive predictive value 80%, negative predictive value 100% and accuracy 96.7%. Endometrial carcinoma was found in 3(10%) cases and showed sensitivity of 100%, specificity of 96.3%, positive predictive value 75.0%, negative predictive value 100% and accuracy 96.7%. For the atrophic endometrium, sensitivity (100%), specificity (96.0%), positive predictive value (83.3%), negative predictive value (100%) and accuracy (96.7%). 1(3.3%) had in situ endometrial carcinoma and 2(6.6%) had adenomyosis on histopathology. Conclusion: The study concludes that hysteroscopy and directed biopsy or fractional curettage is a highly accurate, sensitive, specific, positive predictive value and negative predictive value for diagnosis of cause of postmenopausal bleeding. Bangladesh Medical Res Counc Bull 2023; 49(1): 1-14