Comparison of hysteroscopic and hysterectomy findings for assessing the diagnostic accuracy of office hysteroscopy.

Objective: To assess the diagnostic accuracy of office hysteroscopy by comparing the hysteroscopic findings with the histologic findings on the hysterectomy specimens. Design: Retrospective clinical study. Setting: University-affiliated hospital. Patient(s): Review of the hospital records of 443 patients who underwent office hysteroscopy and, within 2 months, hysterectomy. Intervention(s): We compared the hysteroscopic findings (including targeted biopsies) with the histologic findings that were obtained after hysterectomy. The results of this study were then compared with those of a previous study in which we examined the diagnostic accuracy of dilatation and curettage (D&C). Main Outcome Measure(s): We evaluated the diagnostic accuracy of office hysteroscopy. Result(s): When compared with the histologic diagnosis of the uterus, the hysteroscopic findings showed a diagnostic sensitivity of 98%, a specificity of 95%, a positive predictive value (PPV) of 96%, and a negative predictive value (NPV) of 98%. Hysteroscopy was found to have a greater diagnostic accuracy than D&C: the sensitivity and the NPV of the two diagnostic procedures were statistically different. Conclusion(s): Office hysteroscopy is confirmed as a powerful diagnostic tool, but targeted biopsies, performed with a small diameter operative hysteroscope, must be performed in cases of suspect endometrium to confirm the image-based diagnosis.