Detection of intracavitary lesions in 820 infertile women: comparison of outpatient hysteroscopy with histopathological examination

Abstract

Objectives: The aim of the study was to compare the results of a diagnostic hysteroscopy with a histopathology examination (referential test) in a group of infertile women. Materials and methods: Eight hundred and twenty infertile patients were included in the study. The subjects with intracavitary lesions underwent operative hysteroscopy to enable the removal of polyps and intracavitary myomas. Endometrial biopsy was performed in all patients with no pathologies in hysteroscopy. The removed tissue underwent histopathological examination. Results: The mean age was 32.9 ±4.1. A total of 648 (79%) patients were diagnosed with primary and 172 (21%) with secondary infertility; 542 (66.1%) hysteroscopies were performed with no anesthesia and 278 (33.9%) hysteroscopies were performed in short total intravenous anesthesia. Sensitivity and specificity, accuracy, error, positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy in detecting endometrial lesions were 99.6%, 96.6%, 97.4%, 2.6%, 92.2% (PPV) and 99.8% (NPV), respectively. The agreement between hysteroscopy and pathology report was very high (kappa K=0.94). In case of normal uterine cavity, 562 of the 563 endometrial samples showed evidence of normal endometrium. In all 32 cases of resected submucosal myomas histopathology confirmed the hysteroscopic findings (sensitivity100%, specificity 100%, accuracy 100%, error 0%, kappa K=1.0). Both, hysteroscopy and histopathology confirmed the presence of endometrial polyps in 199 cases. The diagnosis of a polyp was not confirmed in histopathological findings (false-positive results) in 20 hysteroscopies. No endometrial polyps were missed during hysteroscopy. Sensitivity, specificity, accuracy, error, positive and negative predictive values in detecting endometrial polyps were 100%, 96.8%, 97.6%, 2.4%, 90.9% (PPV) and 100% (NPV), respectively. The Kappa coefficient agreement between hysteroscopy and histopathology for endometrial polyps was 0.91. Conclusions: Hysteroscopy is a method of high sensitivity and specificity in detecting pathologies, but in case of a pathology it cannot replace histological examination. Our result show that a routine endometrial biopsy performer in infertile patients with no pathology in hysteroscopy should not be recommended.