The Correlation of Hysteroscopic Diagnosis with Histopathologic Findings in Patients with Post-Menopausal Bleeding: A Retrospective Cross-Sectional Study

Objective: Abnormal uterine bleeding, namely post-menopausal bleeding (PMB), is the most common symptom of intrauterine pathologies in post-menopausal women. This study aimed to investigate the complementary role of hysteroscopy in the management of PMB and the sensitivity of hysteroscopy compared to histopathologic examination in PMB. Material and Methods: This was a retrospective cross-sectional study including patients undergoing hysteroscopy and endometrial curettage. If a local lesion like polyp or myoma uteri was detected, hysteroscopic resection was performed and the tissue was sent for histopathologic examination. If no local lesion was detected, the endometrial cavity was classified as normal, hyperplastic ( thickened, irregular cavity), or atrophic (thin and pale cavity). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of hysteroscopy were calculated for every histopathologic finding. Results: The main hysteroscopic findings were endometrial polyp in 54 (47%) cases, normal cavity in 26 (22.6%), atrophy in 14 (12.1%) cases, hyperplastic endometrium in 11 (9.6%) cases and myoma uteri in 10 (8.7%) cases. The sensitivity, specifity, PPV, NPV and diagnostic accuracy of hysteroscopy for endometrial polyps were 70.0%, 72.0%, 76.0%, 65.0% and 71.0% respectively. In 3 cases, histopathological examination showed endometrial hyperplasia within polyps. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of hysteroscopy for myoma uteri were 87.5%, 96.9%, 70.0%, 99.0% and 97.2% respectively. Conclusion: Hysteroscopy showed lower diagnostic accuracy for endometrial pathologies, especially endometrial cancer, validating the need for histopathologic examination. The diagnosis cannot depend on hysteroscopic assessment alone and histopathologic examination should be performed in all PMB cases.