Page 100 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 5
Table 2. Diagnostic accuracy of SIS as compared to the reference standard hysteroscopy Sensitivity for SIS to diagnose an endometrial polyp 93% for a 94% specificity
SIS Polyp 38 1 1 40 No polyp 3 30 - 33 Inconclusive 5 1 - 6 Total 4632179
In two of 87 women who underwent hysteroscopy, the cavity could not be reached by hysteroscopy because of pain and they refused hysteroscopy under general anaesthesia. In these two women a polyp could be seen in the cervical canal. Biopsy showed benign result in both cases.
Out of 85 women who underwent hysteroscopy successfully, 50 were diagnosed with a polyp (Table 3). In two women, the polyp was not sent for pathology. The pathology results of the other 48 polyps showed hyperplasia with atypia in five women and endometrial cancer in one woman, all six presenting as a focal lesion inside the polyp. Five of six women in whom the Pipelle® had missed a (pre) cancer, had SIS and in four women the polyp had been visualised, while in one woman the SIS had been inconclusive due to bad visibility. All six women with (pre) cancers were treated with hysterectomy and bilateral salpingo-oophorectomy (BSO).The final pathology result in two of the women with hyperplasia with atypia showed an endometrial cancer adding up to three women having endometrial cancer and three women having hyperplasia with atypia. All three women diagnosed with carcinoma had FIGO stage I endometroid adenocarcinoma and did not need adjuvant treatment.
Table 3. Pathology results after hysteroscopy (and hysterectomy) in diagnostic work-up-group (n=87)
Hysteroscopy
Polyp
No polyp
No result
Total
Polyp (n=50)
No polyp (n=35)
Hysteroscopy not possible (n=2)
Polypectomy n=45
Biopsy n=5
Biopsy n=6
Biopsy n=2
No result
Benign
Hyperplasia without atypia Hyperplasia with atypia Endometrial cancer
2 (2.3) 35 (39.1) 2 (2.3) 3 (3.5) 3 (3.5)
-
5 (5.8) -
-
-
-
6 (6.9) -
-
-
-
2 (2.3) -
-
-
Numbers (percentages) of total hysteroscopies
98