Trends in Hysteroscopic Endometrial Sampling in Women 70 Years and Older

Abstract Background: Women 70 years of age or older with suspected endometrial pathologies would especially benefit from office hysteroscopy due to the risks of anesthesia and high rates of clinically significant findings in this age group. However, performing office hysteroscopy in those older patients can be technically challenging, and patient cooperation, which is essential for the success of the office procedure, may be compromised in this age group. The objective of the present study was to characterize the clinical and procedural features of office and operating-room hysteroscopy in women 70 years of age or older.Methods: This was a retrospective chart analysis of all women aged 70 years and older who underwent a hysteroscopy procedure in a single tertiary-care medical center between March 2011 and August 2018. We compared the clinical and procedural characteristics of patients who underwent hysteroscopy in our outpatient clinic to those who underwent hysteroscopy under anesthesia in the operating room. Primary outcomes included procedure success and histopathological findings. Secondary outcomes included short-term complications of the procedure. Results: The data of 577 patients were analyzed. The median age at the time of the procedure was 76 years. 225 office hysteroscopy procedures and 405 operating room procedures were included. Of the 236 patients with postmenopausal bleeding (PMB), 73 (30.9%) were diagnosed with having malignancy compared to 25/341 (7.3%) patients with no PMB (p < .001, odds ratio (OR) = 5.66; confidence interval (CI) 3.46-9.26). The office procedure was successful in 194 (87%) patients. Fifty-three patients required a second hysteroscopy, which revealed 12 cases of premalignant or malignant lesions. The volume of procedures in the office increased 16 times during the study period, and the diagnostic yield of new abnormal findings by means of the procedure in the office setting has increased over time. Operating room hysteroscopy had a higher rate of complications compared to office hysteroscopy, including mortalities related to the procedure.Conclusions: Office hysteroscopy for women over the age of 70 is safe, feasible, and reliable for diagnosis of endometrial malignancy. Failed hysteroscopy and a moderate-to-high index of suspicion for malignancy indicates the need for a repeat hysteroscopy.