Clinical characteristics of endometrium in elder women and the diagnostic value of hysteroscopy

Objective To evaluate the value of hysteroscopy in elder women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. Methods Fifty-three cases in the AUB group and seventy-eight cases in the endometrial hyperplasia group underwent hysteroscopy examination and hysteroscopy-guided biopsy, then the hysteroscopic and histopathological results were compared between the two groups. Results Of the 131 cases, the normal endometrium accounted for 29.8% (n=39), endometrial polyp for 49.6% (n=65), submucous myomas for 4.6% (n=6), hyperplasia endometrii for 6.1%(n=8) and endometrial carcinoma for 9.9% (n=13). Both the AUB group and the endometrial hyperplasia group had 8 cases of endometrial carcinoma (15.1%, 6.4%, respectively). For the diagnosis of normal endometrium with hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 88%, 97%, 94% and 95%, respectively, in the AUB group, versus 82%, 95%, 86% and 93%, respectively, in the endometrial hyperplasia group. For the endometrial polyps, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 100%, 79%, 74%, 100%, respectively, in the AUB group and 98%, 88%, 92%, 97%, respectively, in the endometrial hyperplasia group. For the endometrial cancer, hysteroscopy had a sensitivity, specificity, PPV and NPV of 75%, 100%, 100% and 96%, respectively, in the AUB group; while in the endometrial hyperplasia group, the sensitivity was 80%, the specificity and PPV were 100%, and the NPV was 99%. Conclusions In elder females, hysteroscopy allows for an accurate diagnosis in endometrial disease, and hysteroscopically directed sampling is mandatory, even if the uterine cavity appears normal at hysteroscopy, to rule out endometrial neoplasms. Key words: Hysteroscopy; Endometrial; Uterine hemorrhage