Publication:

Role of hysteroscopy in evaluating patients with abnormal uterine bleeding and its correlation with histopathology

Background Abnormal uterine bleeding (AUB) is a common gynaecological complaint with diverse aetiologies that often require precise evaluation to guide management. Hysteroscopy, by allowing direct visualization of the uterine cavity, has emerged as a superior diagnostic tool compared to traditional methods such as dilation and curettage. Objectives were to determine the spectrum of intrauterine abnormalities contributing to AUB through hysteroscopic evaluation, assess the diagnostic potential of hysteroscopy, and correlate its findings with histopathology.

Methods An analytical observational study was conducted in the department of obstetrics and gynecology at Sparsh Hospital, Bangalore, from January 2023 to December 2024, involving 210 women with AUB. All participants underwent detailed clinical evaluation, transvaginal sonography (TVS), hysteroscopy, and endometrial biopsy. Hysteroscopic findings were compared with histopathological results, and diagnostic validity parameters- sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy- were calculated using SPSS v20.

Results Most patients were aged 41-50 years (35.24%). Heavy menstrual bleeding was the commonest presentation (36.6%). Hysteroscopy revealed endometrial polyps (30.47%) and hyperplasia (21.4%) as predominant findings. Histopathology confirmed polyps in 28.5% and hyperplasia in 18.08%. Hysteroscopy showed sensitivity of 95.18%, specificity of 84.92%, PPV of 82%, NPV of 96.31%, and diagnostic accuracy of 90.05% in comparison to histopathology.

Conclusions Hysteroscopy is a highly accurate, safe, and minimally invasive diagnostic modality for evaluating AUB. When combined with histopathology, it serves as the gold standard for identifying intrauterine pathology and guiding appropriate management.