The Effectivenss of Hysteroscopy in Evaluating Asymptomatic Postmenopausal Patients with Thickened Endometrium

To assess the association between the hysteroscopy and histopathological findings in asymptomatic postmenopausal patients with thickened endometrium. This retrospective study was performed in asymptomatic postmenopausal patients with endometrial thickness that was revealed by transvaginal ultrasonography as > 5mm. Office hysteroscopy and endometrial biopsy were performed to all patients. The outcomes of hysteroscopy and histopathology were compared and sensitivity, specificity, positive and negative predictive values of hysteroscopy were determined. One hundred and sixty-eight patients were evaluated, patients who have not enough data and histopathological findings were excluded. After exclusion criterias, totally 106 patients were analyzed. Mean age(years), age of menopause(years) and endometrial thickness(mm) were 55.3±8.5, 47.8±5.4 and 9.5±4.2 respectively. We assessed the histopathological findings as normal or atrophic, endometrial polyp, simple endometrial hyperplasia, atypical/complex endometrial hyperplasia, endometrial carcinoma and insufficient material in 9(8.5%), 61(57.5%), 6(5.7%), 16(15.1%), 5(4.7%), 1(0.9%) and 8(7.5%) patients, respectively. Hysteroscopic findings were established as normal appearance, hyperplasia, endometrial polyp, submucous myoma and tumor/carcinoma in 30(28.3%), 16(15.1%), 53(50%), 6(5.7%) and 1(0.9%) patients, respectively. Hysteroscopy evaluation was compared with the histopathology which approved as a gold standard procedure to determine the definitive diagnosis and the analysis was performed for each finding separately. The hysteroscopy was more sensitive in normal or atrophic endometrium and endometrial polyps were determined by hysteroscopy with high sensitivity. The lowest sensitivity was obtained in endometrial hyperplasia. Hysteroscopy enables effective and accurate diagnosis to evaluate benign and suspected malign cases in postmenopausal patients with thickened endometrium. The advantages of hysteroscopy were opportunity for concurrent biopsy and detection the correct location of the lesions. Hysteroscopy also eliminates the unnecessary biopsies for atrophic endometrium. The sensitiviy of hysteroscopy increases especially in intracavitary pathologies such as endometrial polyps. It should not be forgotten the necessity of curettage in endometrial hyperplasias that can not be detected clearly with hysteroscop