The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis.

CONTEXT
Hysteroscopy (direct endoscopic visualization of the endometrial cavity) is used extensively in the evaluation of common gynecologic problems, such as menorrhagia and postmenopausal bleeding. However, there is a continuing debate about the value of this technology in the diagnosis of serious endometrial disease.


OBJECTIVE
To determine the accuracy of hysteroscopy in diagnosing endometrial cancer and hyperplasia in women with abnormal uterine bleeding.


DATA SOURCES
Relevant articles were identified through searches of the Cochrane Library, MEDLINE, and EMBASE (1984-2001), manual searches of bibliographies of known primary and review articles, and contact with manufacturers.


STUDY SELECTION
Studies were selected blindly, independently, and in duplicate if accuracy of hysteroscopy was estimated in women with abnormal uterine bleeding, using histopathologic findings as a reference standard. Our search identified 3486 articles; 208 of these were deemed to be potentially eligible and were retrieved for detailed data extraction. Sixty-five primary studies were analyzed, including 26 346 women.


DATA EXTRACTION
Data were abstracted on characteristics and quality from each study. Results for diagnostic accuracy were extracted to form 2 x 2 contingency tables separately for endometrial cancer and endometrial disease (cancer, hyperplasia, or both). Pooled likelihood ratios (LRs) were used as summary accuracy measures.


DATA SYNTHESIS
The pretest probability of endometrial cancer was 3.9% (95% confidence interval [CI], 3.7%-4.2%). A positive hysteroscopy result (pooled LR, 60.9; 95% CI, 51.2-72.5) increased the probability of cancer to 71.8% (95% CI, 67.0%-76.6%), whereas a negative hysteroscopy result (pooled LR, 0.15; 95% CI, 0.13-0.18) reduced the probability of cancer to 0.6% (95% CI, 0.5%-0.8%). There was statistical heterogeneity in pooling of LRs, but an explanation for this could not be found in spectrum composition and study quality. The overall accuracy for the diagnosis of endometrial disease was modest compared with that of cancer, and the results were heterogeneous. The accuracy tended to be higher among postmenopausal women and in the outpatient setting.


CONCLUSION
The diagnostic accuracy of hysteroscopy is high for endometrial cancer, but only moderate for endometrial disease (cancer or hyperplasia).

Accuracy of Hysteroscopy in the Diagnosis of Endometrial Cancer and Hyperplasia

Background. Transcervical resection of endometrial polyps is usually performed in order to exclude atypic and/or malignant endometrial changes, to relieve abnormal uterine bleeding or to improve infertility. Objective. To systematically explore the rationale of transcervical polyp resection. Search strategy. Electronic searches of MEDLINE, EMBASE and The Cochrane Library. Selection criteria. Studies reporting the prevalence of premalignant and/or malignant tissue changes within endometrial polyps, as well as outcomes of endometrial polyp removal in terms of symptom relief and improved fertility were included. Main results. 46 studies met the criteria for inclusion (malignancy: 20 studies including 9,266 women, symptom relief: 15 studies including 1,034 women, infertility: 11 studies including 935 women). Most studies were uncontrolled retrospective case series. Only two randomized controlled trials were identified. The prevalence of premalignant and malignant tissue changes within endometrial poly...

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.3109/00016349.2010.493196

Treatment of endometrial polyps: a systematic review.

Comparison of carbon dioxide and normal saline for uterine distension in outpatient hysteroscopy

Flexible outpatient hysteroscopy without anaesthesia: a safe, successful and well tolerated procedure

Panoramic diagnostic microhysteroscopy was performed in the outpatients department on 976 patients without using any type of anaesthetic. In 889 patients, that is 91%, the examination was successful, while it failed in 87 cases, that is, 9%. In 90% of the patients, the examination caused no pain whatsoever, and none of the patients suffered serious complications, either immediately after the examination of later. Comparison with the definite histological diagnosis showed 100% sensitivity and 86% specificity of microhysteroscopy. We can state that panoramic diagnostic microhysteroscopy performed in the outpatients department has proved to be a reliable examination from a diagnostic point of view, and is moreover safe and without pain for the patients.

Panoramic diagnostic microhysteroscopy: analysis of results obtained from 976 patients.

Panoramic diagnostic microhysteroscopy. Analysis of results obtained from 976 outpatients.

A hard cervix: Microscopic examination revealed that a rare transformation had occurred.

The results of panoramic diagnostic microhysteroscopy are reported in 284 patients with sterility or infertility problems. In 33.5% of the patients, microhysteroscopy revealed uterine pathology; in the majority of cases they were pathologies which are unanimously recognized as being causes of sterility, while in others there were pathologies whose role infertilities is still unclear. There was a good correlation between microhysteroscopy and histology in cases of endometrial hyperplasia and of endometritis, whereas in cases of endometrial polyps and functional diagnosis of the endometrium, the correlation was less satisfactory. Although it is not possible at present to draw definite conclusions about the real value and advantages of microhysteroscopy in the diagnosis of female infertility, we are convinced that it is of great use and that it should be at the basis of any investigation involving the infertile woman.

Panoramic diagnostic microhysteroscopy and female sterility: analysis of results in 284 patients.

INTRODUCTION Primary tuberculosis of the cervix is extremely rare, with only 20 cases reported in the English literature since 1949. Here we report the 21st case--an Italian woman with no risk factors. CASE A 50-year-old Italian nulliparous woman was referred to our gynecology unit for vaginal discharge. Her past history was negative. Colposcopy revealed an ulcerated lesion raising the suspicion of cervical cancer. A biopsy revealed a tuberculosis granuloma, and acid-fast bacillus was identified with Ziehl-Neelsen stain. As no other site of tuberculosis was found, primary cervical tuberculosis was diagnosed. CONCLUSIONS Although rare in industrialized countries, cervical tuberculosis may affect even women without risk factors. It should thus be taken into account in the differential diagnosis of cervical cancer.

Primary tuberculosis of the uterine cervix: keep it in mind.

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