Histeroscopía diagnóstica versus legrado uterino en hemorragia uterina anormal, Hospitales José Carrasco Arteaga y Vicente Corral Moscoso

Abstract

Introduction.- The abnormal uterine bleeding is frequent gynecological consultation. In patients peri- and postmenopausal women should be ruled out neoplastic etiology through endometrial histology.

Objectives.- Study with 84 patients peri and postmenopausal, over 35 years, with abnormal uterine bleeding, in hospitals José Carrasco Arteaga, Vicente Corral Moscoso and Central Dispensary-IESS of Cuenca, to determine sensitivity, specificity and index of plausibility of the hysteroscopy against histology; estimate concordance and compare diagnostic capabilities of hysteroscopic biopsy versus curettage.

Methodology.- Validation of diagnostic testing; and the application form for personal data, diagnostic hysteroscopy and anatomopathological. Data processing in SPSS and Epidat. Determination of sensitivity, specificity, and index of verisimilitude through statistical inference; concordance with the Kappa index; diagnostic capacity with Chi-square test.

Results.- Main age group: women between 35 and 49 years (82.2 % ), mostly perimenopausal. Major alterations: metrorrhagia and menometrorrhagia (73.8 % ). Most frequent diagnoses: histeroscopic: endometrial hypertrophy; histopathology: normal endometrium. Concordance: 51% among hysteroscopy and hysteroscopic biopsy, and 31.4 % with curettage; 60.6 % for hysteroscopic biopsy and 66.2 % for curettage. Histopathological study: high sensitivity and low specificity. Histeroscopic study: low diagnostic efficacy compared with both biopsies. Poor concordance between hysteroscopy and curettage. Hysteroscopic Biopsy: higher diagnostic capacity in front of the curettage (likelihood ratio 18.00, p<0,001 ).

Conclusion.- Hysteroscopy: reliable method to diagnose polyp, myoma and endometrial cancer; little sensitive and entitled to endometrial hyperplasia. Poor concordance between hysteroscopy and curettage. Higher diagnostic capabilities of hysteroscopic biopsy in front of the curettage.