Hysteroscopy, Transvaginal Ultrasound and Histopathology in Evaluation of Abnormal Uterine Bleeding: Which is Best?

Background/Aim: Abnormal uterine bleeding in the pre- postmenopausal women is the most common cause for gynecological referrals. It accounts for up to 33% of patients attending outpatient gynecology outpatient clinics. The popularity of hysteroscopy has been enhanced because it is a simple technique that can be performed in the office. Its specificity and positive predictive value of hysteroscopy is higher than traditional D C. Hysteroscopy has the advantage of diagnosing focal lesions, particularly pedunculated structures, which are frequently missed by endometrial biopsy or D C. The present study aimed to compare the efficacy and the acceptability of transvaginal sonography (TVS), hysteroscopy and endometrial biopsy in diagnosis of the various causes of pre- and post-menopausal bleeding.Material and Methods: This study included 50 premenopausal and postmenopausal patients complaining of abnormal uterine bleeding. All of them were subjected to TVS, hysteroscopy and D C; the results were correlated to the histopathological picture of the endometrium in order to obtain appropriate diagnosis of endometrial lesions.Results: Hysteroscopy was the best tool in detecting endometrial polyp having sensitivity, specificity, PPV and NPV of 100%, 95.8%, 94.7% and 100%, respectively with total accuracy of 97.6%. For submucus myoma hysteroscopy had an accuracy of 100% for all cases diagnosed. For Endometrial hyperplasia hysteroscopy had sensitivity, specificity, PPV and NPV of 90%, 96,8%, 90% and 96.8%, respectively with total accuracy 93.6%. For atrophic endometrium hysteroscopy had 66%, 100%, 100% and 97.5%, respectively with total accuracy of 90.8%. For endometrial carcinoma Hysteroscopy had 50%, 97.5%, 50% and 97.5% with total accuracy of 73.7%.Conclusion: Hysteroscopy could be considered as a gold standard in evaluation of uterine cavity in comparison to TVS D C especially in diagnosing endometrial polyps and submucous myoma. D C and histopathological examination have better accuracy than either hysteroscopy or TVS in diagnosis of hyperplasia and cancer. D C confirms the diagnosis but can miss focal endometrial lesions.