Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding

Nancy A. Towbin, Israel M. Gviazda, Charles M. March
In: American Journal of Obstetrics and Gynecology · 1996 · vol. 174(6) , pp. 1678–1682 · doi:10.1016/s0002-9378(96)70196-5 · PMID:8678126 · W2029263594
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This study compared the effectiveness of office hysteroscopy against transvaginal ultrasonography for diagnosing excessive uterine bleeding in patients.

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Abstract

ObjectiveOur purpose was to compare office hysteroscopy with transvaginal ultrasonography for diagnosing intrauterine pathologic disorders in patients with excessive uterine bleeding, with specimens obtained from either hysterectomy or operative hysteroscopy used to represent the true diagnosis.Study designA total of 149 patients underwent office hysteroscopy between July 1993 and December 1994. They were evaluated for complaints of menorrhagia, metrorrhagia, or postmenopausal bleeding. Data encompassing patient age, gravidity, parity, indication, ultrasonographic and hysteroscopic findings, comfort level, time required, and complications were gathered by resident physicians. Most hysteroscopic examinations were preceded by transvaginal ultrasonography. All patients received premedication with 600 mg of ibuprofen and a paracervical block with 1% lidocaine without epinephrine. Sixty-five patients underwent operative hysteroscopy or hysterectomy later. The pathologic diagnoses of these specimens were compared with hysteroscopic and ultrasonographic findings, and the sensitivity and specificity of each test were calculated.ResultsHysteroscopy was 79% sensitive and 93% specific in diagnosing intracavitary pathologic disorders, whereas transvaginal ultrasonography was only 54% sensitive and 90% specific. One hundred forty-one patients were comfortable during the procedure, and inspection of the uterine cavity was considered adequate in 136. The majority of procedures were completed in <10 minutes. Twenty-six patients underwent operative hysteroscopy and another 39 underwent hysterectomy. No patient who underwent operative hysteroscopy has had a recurrence of abnormal bleeding over a 12- to 30-month follow-up.ConclusionOffice hysteroscopy is a rapid, safe, well-tolerated, and highly accurate means of diagnosing the cause of excessive uterine bleeding. It permits patient and physician to discuss more treatment options before surgery, including outpatient operative hysteroscopic procedures. This means savings in time and in drug, procedure, professional, and hospital costs.

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