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J Am Assoc Gynecol Laparosc. 2000 May;7(2):201-9.

Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction.

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  • 1Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH 44195, USA.

Abstract

STUDY OBJECTIVES:

To review diagnoses, complications, and surgical findings in women treated for abnormal uterine bleeding by operative hysteroscopy, and to assess the accuracy of preoperative transvaginal ultrasound (TVS), saline-infusion sonography (SIS), diagnostic hysteroscopy, and endometrial biopsy.

DESIGN:

Retrospective study (Canadian task force classification II-2).

SETTING:

Tertiary care academic medical center.

PATIENTS:

Three hundred seventy-five women. Intervention. Operative hysteroscopy for abnormal uterine bleeding.

MEASUREMENTS AND MAIN RESULTS:

Main indications for hysteroscopy were postmenopausal bleeding (164 patients, 43.7%) and abnormal premenopausal uterine bleeding (211, 56.3%). Main pathology findings were endometrial polyps (172, 45.9%) and submucous myomas (105, 28%). Polyps had histologic abnormalities in 18 patients. Sensitivity of preoperative diagnostic tools for all intrauterine abnormalities and specifically for myomas and polyps was TVS 74% and 39%, SIS 96% and 96%, hysteroscopy 100% and 99%, and Pipelle biopsy 24% and 10%. The complication rate was 1.3%. Postmenopausal women felt significantly more improvement in symptoms (p = 0.02), and were more satisfied (p </=0.001) than premenopausal women. Only 10 women had repeat surgery for the problem.

CONCLUSION:

Operative hysteroscopy is a safe outpatient procedure and is associated with high satisfaction in carefully selected patients. Hysteroscopy and SIS are better diagnostic tests for intracavitary abnormalities than TVS and endometrial biopsy.

PMID:
10806263
[PubMed - indexed for MEDLINE]
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