The Correlation of Hysteroscopy and Histopathology in Evaluating Abnormal Uterine Bleeding: Observations From a Tertiary Care Center

TL;DR

This study compares hysteroscopy and histopathology in diagnosing abnormal uterine bleeding, finding they agree in most cases and together offer a reliable diagnostic method.

Contribution

The study establishes hysteroscopy-guided biopsy combined with histopathology as a new gold standard for evaluating abnormal uterine bleeding.

Findings

Hysteroscopy and histopathology agreed in 83% of cases for diagnosing abnormal uterine bleeding.

Most participants (78.7%) had a normal uterus according to hysteroscopy findings.

Proliferative endometrium was the most common histopathological finding in study participants.

Abstract

Background: Abnormal uterine bleeding (AUB) is an important clinical entity, and its subtype, heavy menstrual bleeding (HMB), affects 14%-25% of women of reproductive age, potentially impairing their physical, emotional, social, and material quality of life. However, in addition to prior studies that supported the efficacy of hysteroscopy in identifying AUB, this study determined the overall pattern of abnormalities in AUB and correlated the diagnosis through hysteroscopy and histopathology. Additionally, a comparison of ultrasonography was done in this study. This study helps healthcare providers provide timely diagnosis and, thereby, timely interventions in treating different causes of AUB.

Methodology: This hospital-based prospective observational study was conducted at a tertiary care center, including women aged 20-60 admitted with complaints of AUB between September 2022 and June 2024. Participants were selected based on their willingness to participate in the study. A statistical analysis was performed using relevant descriptive statistics and plotting the frequency and percentage. Cohen's kappa was applied to ascertain significant associations and patterns within the dataset.

Results: The study included 47 women who were admitted to the hospital for diagnostic hysteroscopy. A majority of clinical symptoms presented as menorrhagia (17, 36.2%). The hemoglobin (g/dL) ranged from 5.9 to 14.7. Overall, on hysteroscopy, 37 (78.7%) women had a normal uterus. On hysteroscopy, 36 (76.6%) participants showed a normal cervical canal and cervix. In terms of histopathology, a majority of the study population (21, 44.7%) had proliferative endometrium. In terms of the correlation between hysteroscopy and histopathology, the two methods agreed in 83% of cases and disagreed in 17% of cases.

Conclusion: This study confirms that hysteroscopy is a crucial tool for assessing patients with AUB, particularly those with a thick endometrium, across all age groups. It does not replace other diagnostic methods; instead, it enhances them. Hysteroscopic-guided biopsy along with histopathology is now widely regarded as the most reliable method and new gold standard for assessing cases of AUB.

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